Sample records for handicapped patients set

  1. Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients : a long-term follow-up study

    Geertzen, JHB; Dijkstra, PU; van Sonderen, ELP; Groothoff, JW; ten Duis, HJ; Eisma, WH


    Objective: To determine the relationship between impairments, disability and handicap in reflex sympathetic dystrophy (RSD) patients. Design: A long-term follow-up study of upper extremity RSD patients. Setting: A university hospital. Subjects: Sixty-five patients, 3-9 years (mean interval 5.5 years

  2. Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients : a long-term follow-up study

    Geertzen, JHB; Dijkstra, PU; van Sonderen, ELP; Groothoff, JW; ten Duis, HJ; Eisma, WH


    Objective: To determine the relationship between impairments, disability and handicap in reflex sympathetic dystrophy (RSD) patients. Design: A long-term follow-up study of upper extremity RSD patients. Setting: A university hospital. Subjects: Sixty-five patients, 3-9 years (mean interval 5.5

  3. Increasing handicapped preschoolers' peer social interactions: cross-setting and component analysis.

    Odom, S L; Hoyson, M; Jamieson, B.(University of Winnipeg, Department of Physics, Winnipeg, MB, Canada); Strain, P S


    The purposes of our study were: (a) to train a set of observationally determined social behaviors via peer initiation; (b) to determine if effects generalized across classroom settings and to directly intervene if generalization did not occur; and (c) to analyze components of the peer-initiation intervention. After baseline, nonhandicapped preschool children (confederates) were taught to direct social initiations to the three handicapped preschool-aged students. Teachers prompted the confeder...

  4. [A study on thermal regulation disturbance in severely handicapped patients].

    Nishimura, M; Nishimura, S


    Forty-five severely handicapped patients were investigated on body temperature regulation. Poor regulation cases had CT scans showing severe third and lateral ventricle dilatation. Furthermore, in almost all poor regulation cases of perinatal and postnatal onset, CT scans showed extensive low density areas involving the frontal lobe. Electrophysiological studies (sSEP, ABR and blink reflex) could not show definite differences between poor regulation cases and good regulation cases. These findings suggest that hypothalamus, medial forebrain bundle and frontal lobe play important roles in body temperature regulation. On the other hand, perinatal or postnatal onset cases frequently had small body surface areas and low serum creatinine.

  5. The Tinnitus Handicap Inventory as a screening test for psychiatric comorbidity in patients with tinnitus.

    Salviati, Massimo; Macrì, Francesco; Terlizzi, Samira; Melcore, Claudia; Provenzano, Alessandra; Capparelli, Emilia; Altissimi, Giancarlo; Cianfrone, Giancarlo


    Psychiatric comorbidity is common in patients who seek help for tinnitus. The perceived severity of tinnitus correlates closer to psychological and general health factors than to audiometrical parameters. Audiologists need valid screening tools in order to identify patients with psychiatric disorders and to tailor treatment in a multidisciplinary setting. The tinnitus handicap inventory (THI) has gained widespread acceptance as a self-report measure of tinnitus handicap. In several studies, THI test score correlates with the level of psychopathologic distress. The aim of our study was to investigate the predictive power of the test THI in relation to psychiatric disorders. We recruited 156 patients with chronic tinnitus who have requested help at our tinnitus center. All patients underwent psychiatric evaluation, the diagnosis was made in agreement with the DSMIV-TR criteria; all patients filled out the following questionnaires: THI, Symptomatic Check List-90-Revised (SCL-90-R) and Stress-related Vulnerability Scale (VRS). Sensibility and specificity of tests as screening tool for psychiatric disorders was evaluated using Receiver Operating Characteristic (ROC) curve. Sixty-eight patients (prevalence: 43.59%) were found to be affected by a psychiatric disorder. AUC = 0.792 (p > 0.001) shows that THI is a moderately accurate test to individuate psychiatric affected people among our sample. We identified a score of 36 at THI (sensibility = 86.76%; specificity = 59.09%) as an appropriate cut-off point. If a patient reports a THI score greater than 36, the audiologist should supplement diagnostic studies with a psychiatric evaluation. Copyright © 2013 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  6. The natural environment and human development: implications for handicapped children in urban settings

    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.

  7. Increasing handicapped preschoolers' peer social interactions: cross-setting and component analysis.

    Odom, S L; Hoyson, M; Jamieson, B; Strain, P S


    The purposes of our study were: (a) to train a set of observationally determined social behaviors via peer initiation; (b) to determine if effects generalized across classroom settings and to directly intervene if generalization did not occur; and (c) to analyze components of the peer-initiation intervention. After baseline, nonhandicapped preschool children (confederates) were taught to direct social initiations to the three handicapped preschool-aged students. Teachers prompted the confederates to engage the students in social interaction when necessary and rewarded the confederates with tokens. Confederates' initiations to the students resulted in increased frequencies of positive social interaction. There was no generalization to other classroom settings, and the intervention was subsequently implemented in a second and third classroom. Next, the confederates' token reinforcement system was withdrawn, with no apparent deleterious effects on the confederates' or students' social interactions. When teachers substantially reduced their prompts to the confederates, students' social interactions decreased. Finally, reinstatement of teacher prompts resulted in increases in the confederates' social initiations and, consequently, the positive social interactions of the students.

  8. Assessment of auditory and psychosocial handicap associated with unilateral hearing loss among Indian patients.

    Augustine, Ann Mary; Chrysolyte, Shipra B; Thenmozhi, K; Rupa, V


    In order to assess psychosocial and auditory handicap in Indian patients with unilateral sensorineural hearing loss (USNHL), a prospective study was conducted on 50 adults with USNHL in the ENT Outpatient clinic of a tertiary care centre. The hearing handicap inventory for adults (HHIA) as well as speech in noise and sound localization tests were administered to patients with USNHL. An equal number of age-matched, normal controls also underwent the speech and sound localization tests. The results showed that HHIA scores ranged from 0 to 60 (mean 20.7). Most patients (84.8 %) had either mild to moderate or no handicap. Emotional subscale scores were higher than social subscale scores (p = 0.01). When the effect of sociodemographic factors on HHIA scores was analysed, educated individuals were found to have higher social subscale scores (p = 0.04). Age, sex, side and duration of hearing loss, occupation and income did not affect HHIA scores. Speech in noise and sound localization were significantly poorer in cases compared to controls (p handicap. When present, the handicap is more emotional than social. USNHL significantly affects sound localization and speech in noise. Yet, affected patients seldom seek a rehabilitative device.

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

    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

  10. Relation between Voice Handicap Index (VHI) and disease severity in Iranian patients with Parkinson's disease

    Majdinasab, Fatemeh; Karkheiran, Siamak; Moradi, Negin; Shahidi, Gholam Ali; Salehi, Masoud


    Background One third of patients with Parkinson's disease (PD) have mentioned “dysphonia” as their most debilitating communication deficit. Patient-based measurements, such as Voice Handicap Index (VHI) add necessary supplementary information to clinical and physiological assessment. There are a few studies about relation between VHI and disease severity in PD, although none of them showed any significant correlation. The goal of this study was to find correlation between these variables in I...

  11. Comparison of Acoustic and Stroboscopic Findings and Voice Handicap Index between Allergic Rhinitis Patients and Controls

    Koç, Eltaf Ayça Özbal; Koç, Bülent; Erbek, Selim


    Background: In our experience Allergic Rhinitis (AR) patients suffer from voice problems more than health subjects. Aims: To investigate the acoustic analysis of voice, stroscopic findings of larynx and Voice Handicap Index scores in allergic rhinitis patients compared with healthy controls. Study Design: Case-control study. Methods: Thirty adult patients diagnosed with perennial allergic rhinitis were compared with 30 age- and sex-matched healthy controls without allergy. All assessments were performed in the speech physiology laboratory and the testing sequence was as follows: 1. Voice Handicap Index (VHI) questionnaire, 2. Laryngovideostroboscopy, 3. Acoustic analyses. Results: No difference was observed between the allergic rhinitis and control groups regarding mean Maximum Phonation Time (MPT) values, Fo values, and stroboscopic assessment (p>0.05). On the other hand, mean VHI score (p=0.001) and s/z ratio (p=0.011) were significantly higher in the allergic rhinitis group than in controls. Conclusion: Our findings suggest that the presence of allergies could have effects on laryngeal dysfunction and voice-related quality of life. PMID:25667789

  12. Validation of the Persian version of the dysphagia handicap index in patients with neurological disorders.

    Barzegar-Bafrooei, Ebrahim; Bakhtiary, Jalal; Khatoonabadi, Ahmad Reza; Fatehi, Farzad; Maroufizadeh, Saman; Fathali, Mojtaba


    Dysphagia as a common condition affecting many aspects of the patient's life. The Dysphagia Handicap Index (DHI) is a reliable self-reported questionnaire developed specifically to measure the impact of dysphagia on the patient's quality of life. The aim of this study was to translate the questionnaire to Persian and to measure its validity and reliability in patients with neurogenic oropharyngeal dysphagia. A formal forward-backward translation of DHI was performed based on the guidelines for the cross-cultural adaptation of self-report measures. A total of 57 patients with neurogenic dysphagia who were referred to the neurology clinics of Tehran University of Medical Sciences, Iran, participated in this study. Internal consistency reliability of the DHI was examined using Cronbach's alpha, and test-retest reliability of the scale was evaluated using intraclass correlation coefficient (ICC). The internal consistency of the Persian DHI (P-DHI) was considered to be good; Cronbach's alpha coefficient for the total P-DHI was 0.88. The test-retest reliability for the total and three subscales of the P-DHI ranged from 0.95 to 0.98 using ICC. The P-DHI demonstrated a good reliability, and it can be a valid instrument for evaluating the dysphagia effects on quality of life among Persian language population.

  13. Evaluation of headache intensity in migrainous patients with visual handicap through the tactile analogical scale (TAS

    Piovesan Elcio Juliato


    Full Text Available The tactile analogue scale (TAS was elaborated to be used in blind subjects or those who can not use the vision during their crises. The objective of this study was to characterize, from TAS, the architecture of migraine attacks in subjects with visual disability. For that, 11 migrainous with visual disturb (MVD subjects were studied and 22 migrainous subjects with no visual disability as a control group. All patients fulfilled the criteria for migraine and the patients of the group studied showed visual acuteness less than 20/200. To evaluate the results, the patients of the group MVD were subdivide within two groups, according to their visual acuteness: subgroup A subjects with subnormal vision and subgroup B amaurotic ones. In subgroup A measurement 46 attacks with average of the migraine attacks of the 56.50 mm, in the subgroup B 45 attacks with average of the 59.58mm and in the control group 92 attacks with average of the 49.88mm. When subgroup B and control group were compared there was a significant statistic difference (p=0.022. Through these outcomes we can observe that the migrainous subjects with no visual afference show a higher pain intensity during the migraine crises comparing to those subjects with no visual handicap. The study suggests that, as in other forms of sensibility, the total visual loss can also interfere in the nociceptive control of the pain during the migraine attacks.

  14. Protect Rights and Interests of the Handicapped



    @@ Yuncheng is a city in the southwestern part of North China's Shanxi Province. It has a handicapped population of 223,000 or 4.5% of the total population of 4.985 million. The city has made big progress in protecting the rights and interests of handicapped people since the handicapped associations were set up at the city and county levels.

  15. The impact of vocal rehabilitation on quality of life and voice handicap in patients with total laryngectomy

    Cristina Tiple


    Full Text Available Background: Health-related quality of life (HRQL and voice handicap index (VHI of laryngectomies seem to be relevant regarding voice rehabilitation. The aim of this study is to assess the impact on HRQL and VHI of laryngectomies, following voice rehabilitation. Materials and Methods: A retrospective study done at the Ear, Nose, and Throat Department of the Emergency County Hospital. Sixty-five laryngectomees were included in this study, of which 62 of them underwent voice rehabilitation. Voice handicap and QOL were assessed using the QOL questionnaires developed by the European Organisation for Research and Treatment of Cancer (EORTC; variables used were functional scales (physical, role, cognitive, emotional, and social, symptom scales (fatigue, pain, and nausea and vomiting, global QOL scale (pain, swallowing, senses, speech, social eating, social contact, and sexuality, and the functional, physical, and emotional aspects of the voice handicap (one-way ANOVA test. Results: The mean age of the patients was 59.22 (standard deviation = 9.00 years. A total of 26 (40% patients had moderate VHI (between 31 and 60 and 39 (60% patients had severe VHI (higher than 61. Results of the HRQL questionnaires showed that patients who underwent speech therapy obtained better scores in most scales (P = 0.000. Patients with esophageal voice had a high score for functional scales compared with or without other voice rehabilitation methods (P = 0.07, and the VHI score for transesophageal prosthesis was improved after an adjustment period. The global health status and VHI scores showed a statistically significant correlation between speaker groups. Conclusion: The EORTC and the VHI questionnaires offer more information regarding life after laryngectomy.

  16. [Handicapped patients and leisure sports--a chance for social integration].

    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.

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

    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.

  18. [Basis for information transmission with biosignals for development of technical communication aids for handicapped patients].

    Wiebe, P


    For the design of communication aids controlled by biosignals for the handicapped, an analysis of the aspects of the significance of information is mandatory. The definition of information in its five aspects statistics, syntax, semantics, pragmatics and apobetics, enables us to conclude that the transmission of information is possible only with voluntarily influenceable biosignal components. The voluntary influencing of the biosignal may be interpreted as a modulation of the amplitude density of the Fourier integral. By calculating the highest possible statistical information content of a biosignal, it is possible to estimate the technical complexity of a biosignal-based communication system. The construction of efficient communication aids is possible when many biosignal components that can be readily and rapidly controlled voluntarily are to be found.

  19. The Norwegian Voice Handicap Index (VHI-N) patient scores are dependent on voice-related disease group.

    Karlsen, Tom; Heimdal, John-Helge; Grieg, Anne Rita Hella; Aarstad, Hans Jørgen


    The aim of this study is to determine to what extent the Voice Handicap Index-Norwegian (VHI-N) is scored depending on specific laryngological disease. In a multi-center study, 126 healthy subjects and 355 patients with different voice-related diseases answered the VHI-N. The VHI-N scores showed high Cronbach's alpha. Analyses of variance were performed with VHI-N dependent and specific voice-related disease as independent variable, and showed highly significant dependence by group allocation (F(7,461) = 28.0; p VHI-N scores. The VHI-N is a psychometrically well-functioning instrument, also at disease-specific levels and discriminates well between health and voice diseases, as well as between different voice-related diseases. The VHI-N may be recommended to be used when monitoring voice-related disease treatment.

  20. Validity and reliability of the Korean version of the Speech Handicap Index in patients with oral cavity cancer.

    Park, S S; Choi, S H; Hong, J A; Hong, Y H; Jeong, N G; Lee, S Y; Sung, M-W; Hah, J H


    The aims of this study were to evaluate the cross-cultural adaptation of the Speech Handicap Index (SHI) for Korean subjects and to determine its reliability and utility in patients with oral cavity cancer. The Korean version of the SHI was administered to 50 healthy subjects and 56 patients with speech problems resulting from treatment for oral cavity cancers. The content and construct validity, internal consistency, and test-retest reliability were examined. Healthy subject and patient group scores were compared, and the Mann-Whitney U-test was used to determine discriminatory ability. The Korean version of the SHI had high internal consistency (Cronbach's alpha=0.99) and test-retest reliability for the total and subscales: total (T) 0.98, speech (S) 0.99, and psychosocial (P) 0.97. Mean scores in the healthy group were 0.5 (T), 0.2 (S), and 0.2 (P), whereas those in the patient group were 34.3 (T), 16.6 (S), and 15.5 (P). The scores differed significantly between the groups (P<0.05). The Korean version of the SHI can be a useful tool to evaluate a patient's self-perception of their speech dysfunction in daily life and to better understand postoperative speech disorders in patients with oral cavity cancer.

  1. The lack of antiepileptic drugs and worsening of seizures among physically handicapped patients with epilepsy during the Great East Japan Earthquake.

    Kobayashi, Satoru; Endo, Wakaba; Inui, Takehiko; Wakusawa, Keisuke; Tanaka, Soichiro; Onuma, Akira; Haginoya, Kazuhiro


    Takuto Rehabilitation Center for Children is located in Sendai, the capital of the Miyagi prefecture, and faces the Pacific Ocean. The tsunami caused by the Great East Japan Earthquake resulted in tremendous damage to this region. Many physically handicapped patients with epilepsy who are treated at our hospital could not obtain medicine. We surveyed patients with epilepsy, using a questionnaire to identify the problems during the acute phase of the Great East Japan Earthquake. After the earthquake, we mailed questionnaires to physically handicapped patients with epilepsy who are treated and prescribed medications at our hospital, or to their parents. A total of 161 respondents completed the questionnaire. Overall, 68.4% of patients had seven days or less of stockpiled medication when the earthquake initially struck, and 28.6% of patients had no medication or almost no medication during the acute phase after the earthquake. Six patients were forced to stop taking their medication and nine patients experienced a worsening of seizures. Most (93.6%) patients stated they require a stockpile of medication for more than seven days: 20months after the earthquake, 76.9% patients a supply of drugs for more than seven days. We suggest that physically handicapped patients with epilepsy are recommended to prepare for natural disasters by stockpiling additional medication. Even if the stock of antiepileptic drugs is sufficient, stress could cause worsening of seizures. Specialized support is required after a disaster among physically handicapped patients with epilepsy. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  2. Validation of the Persian version of ‎the dysphagia handicap index in ‎patients with neurological disorders

    Ebrahim Barzegar-Bafrooei


    Full Text Available Background: Dysphagia as a common condition affecting many aspects of the patient’s life. The Dysphagia Handicap Index (DHI is a reliable self-reported questionnaire developed specifically to measure the impact of dysphagia on the patient’s quality of life. The aim of this study was to translate the questionnaire to Persian and to measure its validity and reliability in patients with neurogenic oropharyngeal dysphagia.Methods: A formal forward-backward translation of DHI was performed based on the guidelines for the cross-cultural adaptation of self-report measures. A total of 57 patients with neurogenic dysphagia who were referred to the neurology clinics of Tehran University of Medical Sciences, Iran, participated in this study. Internal consistency reliability of the DHI was examined using Cronbach’s alpha, and test-retest reliability of the scale was evaluated using intraclass correlation coefficient (ICC.Results: The internal consistency of the Persian DHI (P-DHI was considered to be good; Cronbach’s alpha coefficient for the total P-DHI was 0.88. The test-retest reliability for the total and three subscales of the P-DHI ranged from 0.95 to 0.98 using ICC.Conclusion: The P-DHI demonstrated a good reliability, and it can be a valid instrument for evaluating the dysphagia effects on quality of life among Persian language population.




  4. Avaliação do Voice Handicap Index em pacientes com perda auditiva neurossensorial bilateral a partir de grau moderado Voice Handicap Index evaluation in patients with moderate to profound bilateral sensorineural hearing loss

    Felipe Barbosa Madeira


    Full Text Available A produção da voz e da fala é processo que envolve mecanismos reguladores dependentes da audição. As alterações vocais em pacientes com perda auditiva ainda não foram avaliadas quanto ao grau subjetivo de incapacidade que trazem a este grupo. OBJETIVO: Comparar os resultados do Voice Handicap Index (VHI em pacientes com e sem perda auditiva neurossensorial bilateral a partir de grau moderado. FORMA DE ESTUDO: Estudo transversal controlado. MATERIAL E MÉTODO: Foram avaliados 76 pacientes adultos (38 com e 38 sem perda auditiva entre 19 e 59 anos, atendidos em serviço terciário de otorrinolaringologia mediante preenchimento do VHI. RESULTADOS: A mediana da pontuação total do VHI obtida no grupo de pacientes e controle foi de 23,5 e 4,0, respectivamente (p = 0,000. Diferenças significativas entre os dois grupos também foram conseguidas nas medianas dos subitens funcional, físico e emocional do VHI (p = 0,000. CONCLUSÃO: Os resultados obtidos permitem verificar a maior desvantagem social e econômica conforme avaliada pelo VHI em pacientes com perda auditiva neurossensorial bilateral a partir de grau moderado.Voice and speech are regulated by hearing. Vocal disorders in patients with hearing loss have not been evaluated yet as to the subjective degree of disability they cause in this group. AIM: to compare the results of the Voice Handicap Index (VHI obtained for patients with normal hearing and moderate to profound bilateral sensorineural hearing loss. STUDY DESIGN: Controlled, cross-sectional. MATERIALS AND METHODS: A total of 76 adult patients being treated on a University Otolaryngology center were enrolled (38 with and 38 without hearing loss, ages ranging between 19 and 59 years, were asked to complete the Portuguese version of the VHI. RESULTS: Total VHI score median values obtained were 23.5 and 4.0 for the study and control groups, respectively (p = 0.000. Significant differences between the two groups were found for all

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

    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.

  6. Monitoring the Hearing Handicap and the Recognition Threshold of Sentences of a Patient with Unilateral Auditory Neuropathy Spectrum Disorder with Use of a Hearing Aid.

    Lima, Aline Patrícia; Mantello, Erika Barioni; Anastasio, Adriana Ribeiro Tavares


    Introduction Treatment for auditory neuropathy spectrum disorder (ANSD) is not yet well established, including the use of hearing aids (HAs). Not all patients diagnosed with ASND have access to HAs, and in some cases HAs are even contraindicated. Objective To monitor the hearing handicap and the recognition threshold of sentences in silence and in noise in a patient with ASND using an HA. Resumed Report A 47-year-old woman reported moderate sensorineural hearing loss in the right ear and high-frequency loss of 4 kHz in the left ear, with bilateral otoacoustic emissions. Auditory brainstem response suggested changes in the functioning of the auditory pathway (up to the inferior colliculus) on the right. An HA was indicated on the right. The patient was tested within a 3-month period before the HA fitting with respect to recognition threshold of sentences in quiet and in noise and for handicap determination. After HA use, she showed a 2.1-dB improvement in the recognition threshold of sentences in silence, a 6.0-dB improvement for recognition threshold of sentences in noise, and a rapid improvement of the signal-to-noise ratio from +3.66 to -2.4 dB when compared with the same tests before the fitting of the HA. Conclusion There was a reduction of the auditory handicap, although speech perception continued to be severely limited. There was a significant improvement of the recognition threshold of sentences in silence and in noise and of the signal-to-noise ratio after 3 months of HA use.

  7. Monitoring the Hearing Handicap and the Recognition Threshold of Sentences of a Patient with Unilateral Auditory Neuropathy Spectrum Disorder with Use of a Hearing Aid

    Lima, Aline Patrícia


    Full Text Available Introduction Treatment for auditory neuropathy spectrum disorder (ANSD is not yet well established, including the use of hearing aids (HAs. Not all patients diagnosed with ASND have access to HAs, and in some cases HAs are even contraindicated. Objective To monitor the hearing handicap and the recognition threshold of sentences in silence and in noise in a patient with ASND using an HA. Resumed Report A 47-year-old woman reported moderate sensorineural hearing loss in the right ear and high-frequency loss of 4 kHz in the left ear, with bilateral otoacoustic emissions. Auditory brainstem response suggested changes in the functioning of the auditory pathway (up to the inferior colliculus on the right. An HA was indicated on the right. The patient was tested within a 3-month period before the HA fitting with respect to recognition threshold of sentences in quiet and in noise and for handicap determination. After HA use, she showed a 2.1-dB improvement in the recognition threshold of sentences in silence, a 6.0-dB improvement for recognition threshold of sentences in noise, and a rapid improvement of the signal-to-noise ratio from +3.66 to −2.4 dB when compared with the same tests before the fitting of the HA. Conclusion There was a reduction of the auditory handicap, although speech perception continued to be severely limited. There was a significant improvement of the recognition threshold of sentences in silence and in noise and of the signal-to-noise ratio after 3 months of HA use.

  8. [Validation of the German version of the Vertigo Handicap Questionnaire (VHQ) in patients with vestibular vertigo syndromes or somatoform vertigo and dizziness].

    Tschan, Regine; Wiltink, Jörg; Best, Christoph; Beutel, Manfred; Dieterich, Marianne; Eckhardt-Henn, Annegret


    The Vertigo Handicap Questionnaire (VHQ) by Yardley (1992) assesses physical and psychosocial impairments of vertigo or dizziness. Our study examines the structure, reliability, and aspects of validity of the German version of the VHQ. 98 vestibular vertigo syndromes vs. 90 patients with somatoform vertigo and dizziness were evaluated with the VHQ, symptom severity (VSS), distress (GSI), anxiety and depression (HADS), catastrophizing beliefs (ACQ), fear of body sensations (BSQ), and quality of life (SF-36). For diagnostic classification detailed clinical neurological, neuro-otological and psychosomatic testing were conducted. Principal components analysis identified two factors, which could be confirmed by confirmatory factor analyses: 'handicapped activity'(VHQ-ACT) and 'anxiety' (VHQ-ANX). The VHQ had good internal consistency (Cronbach's alpha: 0.92). Test-retest reliability was r = 0.80. We noted close relations between the VHQ, the VSS and measures of emotional distress as aspects of good construct validity. Together with the VSS, the VHQ completes a comprehensive diagnostic screening tool for vertigo or dizziness.

  9. The Dance Within: A Pilot Project in Dance for the Handicapped and Teaching Dance for the Handicapped: A Curriculum Guide.

    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…

  10. 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 ml/kg predicted body weight with plateau pressurerespiratory rate 20 to 35 breaths per minute); and d) prevention of hyperoxia (titrate inspired oxygen concentration to peripheral oxygen saturation (SpO2) levels of 88 to 95%). Most patients tolerate lung protective mechanical ventilation well without the need for excessive sedation. Patients with a stiff chest wall may tolerate higher plateau pressure targets (approximately 35 cmH2O) while those with severe ARDS and ventilator asynchrony may require a short-term neuromuscular blockade. Given the difficulty in timely identification of patients with or at risk of ARDS and both the safety and potential benefit in patients without ARDS, lung-protective mechanical ventilation is recommended as an initial approach to mechanical ventilation in both perioperative and critical care settings.

  11. Information Prosthetics for the Handicapped. Final Report.

    Papert, Seymour A.

    The paper describes the successful use of the LOGO System (an interactive graphics, computer based learning environment) with 12 severely physically handicapped adolescents with cerebral palsy. Five goals were set forth concerning the opportunity to work with microcomputers in interesting ways, the assessment of the students' spatial competence,…

  12. Aids for Handicapped Readers.

    Library of Congress, Washington, DC. Div. for the Blind and Physically Handicapped.

    The reference circular provides information on approximately 50 reading and writing aids intended for physically or visually handicapped individuals. Described are low vision aids, aids for holding a book or turning pages, aids for reading in bed, handwriting aids, typewriters and accessories, braille writing equipment, sound reproducers, and aids…

  13. Handicap som risikofaktor?

    Bøttcher, Louise; Dammeyer, Jesper Herup


    psykopatologi etableres. I artiklen vil vi præsentere en almen model til forståelse af mennesker med handicap og deres udviklingsmuligheder – en handicappsykologisk udviklingsmodel ud fra et dialektisk kultur-historisk perspektiv (Vygotsky, (1924-31) 1993). Ved hjælp af empiriske studier vil vi eksemplificere...

  14. Voice handicap in singers.

    Murry, Thomas; Zschommler, Anne; Prokop, Jan


    The study aimed to determine the differences in responses to the Voice Handicap Index (VHI-10) between singers and nonsingers and to evaluate the ranked order differences of the VHI-10 statements for both groups. The VHI-10 was modified to include statements related to the singing voice for comparison to the original VHI-10. Thirty-five nonsingers with documented voice disorders responded to the VHI-10. A second group, consisting of 35 singers with voice complaints, responded to the VHI-10 with three statements added specifically addressing the singing voice. Data from both groups were analyzed in terms of overall subject self-rating of voice handicap and the rank order of statements from least to most important. The difference between the mean VHI-10 for the singers and nonsingers was not statistically significant, thus, supporting the validity of the VHI-10. However, the 10 statements were ranked differently in terms of their importance by both groups. In addition, when three statements related specifically to the singing voice were substituted in the original VHI-10, the singers judged their voice problem to be more severe than when using the original VHI-10. The type of statements used to assess self-perception of voice handicap may be related to the subject population. Singers with voice problems do not rate their voices to be more handicapped than nonsingers unless statements related specifically to singing are included.

  15. Mainstreaming: Visually Handicapped Students

    Porter, Ernestine; And Others


    A research project at Florida State University developed teaching materials for secondary home economics teachers faced with teaching hand and machine sewing and other clothing construction skills to visually handicapped students. The article gives some suggestions for presenting instructions and adapting equipment for cutting and sewing garments.…

  16. Evaluation of speech outcomes using English version of the Speech Handicap Index in a cohort of head and neck cancer patients.

    Dwivedi, Raghav C; St Rose, Suzanne; Chisholm, Edward J; Bisase, Brian; Amen, Furrat; Nutting, Christopher M; Clarke, Peter M; Kerawala, Cyrus J; Rhys-Evans, Peter H; Harrington, Kevin J; Kazi, Rehan


    The aim of this study was to explore post-treatment speech impairments using English version of Speech Handicap Index (SHI) (first speech-specific questionnaire) in a cohort of oral cavity (OC) and oropharyngeal (OP) cancer patients. Sixty-three consecutive OC and OP cancer patients in follow-up participated in this study. Descriptive analyses have been presented as percentages, while Mann-Whitney U-test and Kruskall-Wallis test have been used for the quantitative variables. Statistical Package for Social Science-15 statistical software (SPSS Inc., Chicago, IL) was used for the statistical analyses. Over a third (36.1%) of patients reported their speech as either average or bad. Speech intelligibility and articulation were the main speech concerns for 58.8% and 52.9% OC and 31.6% and 34.2% OP cancer patients, respectively. While feeling of incompetent and being less outgoing were the speech-related psychosocial concerns for 64.7% and 23.5% OC and 15.8% and 18.4% OP cancer patients, respectively. Worse speech outcomes were noted for oral tongue and base of tongue cancers vs. tonsillar cancers, mean (SD) values were 56.7 (31.3) and 52.0 (38.4) vs. 10.9 (14.8) (Pspeech in HNC patients. Over one-third of OC and OP cancer patients reported speech problems in their day-do-day life. Advanced T-stage tumors affecting the oral tongue or base of tongue are particularly associated with poor speech outcomes.

  17. Handicap, Architecture & Design


    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.......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....

  18. Benefits for handicapped children


    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

  19. Perfecting patient flow in the surgical setting.

    Amato-Vealey, Elaine J; Fountain, Patricia; Coppola, Deborah


    Reduced surgical efficiency and productivity, delayed patient discharges, and prolonged use of hospital resources are the results of an OR that is unable to move patients to the postanesthesia care unit or other patient units. A primary reason for perioperative patient flow delay is the lack of hospital beds to accommodate surgical patients, which consequently causes backups of patients currently in the surgical suite. In one facility, implementing Six Sigma methodology helped to improve OR patient flow by identifying ways that frontline staff members could work more intelligently and more efficiently, and with less stress to streamline workflow and eliminate redundancy and waste in ways that did not necessitate reducing the number of employees. The results were improved employee morale, job satisfaction and safety, and an enhanced patient experience.

  20. 38 CFR 21.58 - Redetermination of employment handicap and serious employment handicap.


    ... employment handicap and serious employment handicap. 21.58 Section 21.58 Pensions, Bonuses, and Veterans... of employment handicap and serious employment handicap. (a) Prior to induction into a program. A determination as to employment handicap, serious employment handicap, or eligibility for a program of...

  1. Patient Advocacy in an Obstetric Setting.

    Heelan-Fancher, Lisa M


    A correlation study design was used to examine the interrelatedness of power, attitudes regarding intermittent fetal monitoring, and perceived barriers to research utilization with a labor and delivery nurse's attitude toward patient advocacy using the conceptual framework of the science of unitary human beings. The linear combination of the three independent variables was significantly correlated to attitude toward patient advocacy and power as knowing participation in change had the greatest impact on patient advocacy.

  2. Older Patients in the Acute Setting

    Ekmann, Anette Addy; Nygaard, Hanne; Wejse, Miriam

    -two (72) and 96 of control and case patients, respectively accepted participation in the study. On average 3.7 patients was enrolled in our GATE daily. At enrollment, average age was 81 years (65-101), 71 % had polypharmacy (>5 pharmaceuticals) and 58 % had more than 3 simultaneous present diseases...

  3. 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.

    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.

  4. Scoring and Standard Setting with Standardized Patients.

    Norcini, John J.; And Others


    The continuous method of scoring a performance test composed of standardized patients was compared with a derivative method that assigned each of the 131 examinees (medical residents) a dichotomous score, and use of Angoff's method with these scoring methods was studied. Both methods produce reasonable means and distributions of scores. (SLD)

  5. Consensus Report of the XI Congress of the Spanish Society of Odontology for the Handicapped and Special Patients

    Machuca Portillo, Guillermo; Cabrerizo Merino, María del Carmen; Cutando Soriano, Antonio; Giménez Prats, María José; Silvestre Donat, Francisco Javier; Tomás Carmona, Inmaculada


    This article summarizes the findings of consensus of the XI congress of the SEOEME. All of these conclusions are referring to the review articles responsible to the general rapporteurs in order to bringing up to date knowledge with regard to the use of implants in patients medically compromised and with special needs and, in the dental management of autism and cerebral palsy, in the dental treatment of patients with genetic and adquired haematological disorders, the dental implications of car...

  6. Consensus report of the XI Congress of the Spanish Society of Odontology for the handicapped and special patients.

    Machuca-Portillo, Guillermo; Cabrerizo-Merino, Carmen; Cutando-Soriano, Antonio; Giménez-Prats, María-José; Silvestre-Donat, Farncisco-Javier; Tomás-Carmona, Inmaculada


    This article summarizes the findings of consensus of the XI congress of the SEOEME. All of these conclusions are referring to the review articles responsible to the general rapporteurs in order to bringing up to date knowledge with regard to the use of implants in patients medically compromised and with special needs and, in the dental management of autism and cerebral palsy, in the dental treatment of patients with genetic and adquired haematological disorders, the dental implications of cardiovascular disease and hospital dentistry.

  7. [The smokers voice self assessment based on Voice Handicap Index (VHI)].

    Wiskirska-Woźnica, Bozena; Wojnowski, Waldemar


    Complex voice assessment due to European Laryngeal Society proposals (2000) contains voice self estimation based on the Polish version of the Voice Handicap Index (VHI). This study focuses on the relation between voice handicap and smoking in dysphonic patients, who are using voice professionally. Thirty outpatient (25 female and 5 male, aged 40 to 55 years) voice department attendees suffering from professional dysphonia took part in this study. All patients after phoniatric examination completed the Polish version of the Voice Handicap Index (VHI). The questions concern functional, emotional and physical complains due to dysphonia. Most of smokers did not complain of dysphonia related problems comparing to non smokers. Even the scores of functional and emotional scales of VHI in smokers shown better results (less handicap) than in nonsmokers. Smoking does not affect patients handicap due to dysphonia measured in the Voice Handicap Index.

  8. Validity of Italian adaptation of the Dizziness Handicap Inventory (DHI) and evaluation of the quality of life in patients with acute dizziness.

    Nola, G; Mostardini, C; Salvi, C; Ercolani, A P; Ralli, G


    The impact of dizziness on Quality of Life (QoL) can be assessed by the Dizziness Handicap Inventory (DHI), which is used as a discriminative and evaluative tool. Although the DHI is available in several languages, an equivalent version for the Italian population is not yet available. Aim of this study was to translate the DHI into the Italian language (DHI-I), assess its correlation to the Italian version of the Short Form-36 Health Survey and to investigate its reliability in evaluating the QoL of patients with acute dizziness. The study population consisted of 50 patients (76% females and 24% males), mean age 51.6 years, range 25-85 years (SD = 14.5). A cross-sectional design was used to examine the internal consistency (Cronbach's α) and concurrent validity (Pearson's product moment correlation r). The application followed the stages of translation from English to Italian and linguistic adaptation, grammatical and idiomatic equivalence review. To confirm the external validity of DHI-I, the Pearson correlation test between the total score and single subscales of DHI-I and the 8 scales of the Short Form Health Survey (SF-36) was performed. The Cronbach α coefficients for internal consistency were 0.92 for the DHI-I and 0.82, 0.84 and 0.75 for the sub-scale functional, emotional and physical, respectively. The frequency distribution of no one item showed a percentage higher than 75% in a single possible answer (0, 2, 4), excluding a ceiling or floor effect. Correlations with the total score of DHI-I were consistent and the correlation between total score of DHI-I and total score on SF-36 was -0.593. Of the single subscales, the emotional scale showed a closer correlation with almost all scales of the SF-36. The correlation between the total score of SF-36 and the single sub-scale of DHI-I (functional, emotional, physical) were respectively -0.599, -0.563, -0.398. The DHI was culturally and linguistically adapted for its application in the Italian population. The

  9. Hospital Patients and Handicapped Readers Section and Round Table of Libraries for the Blind. Libraries Serving the General Public Division. Papers.

    International Federation of Library Associations, The Hague (Netherlands).

    Papers on hospital and health libraries and library services to the blind and deaf which were presented at the 1982 International Federation of Library Associations conference include: (1) "Leisure Pursuits of the Blind" by Antun Lastric (Yugoslavia); (2) "Library Services for the Handicapped in Canada: An Overview" by…

  10. Exploring nurses' and patients' perspectives of limit setting in a forensic mental health setting.

    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.

  11. Making Facilities Accessible to the Physically Handicapped.

    State Univ. Construction Fund, Albany, NY.

    Guidelines on performance criteria for the State University of New York consider two main types of handicapped: the ambulant and semi-ambulant, including some physically handicapped, the visually and aurally handicapped, and persons with cardiac conditions; and persons confined to wheel chairs. The handicapped and planning for them are discussed.…

  12. 29 CFR 779.409 - Handicapped workers.


    ... 29 Labor 3 2010-07-01 2010-07-01 false Handicapped workers. 779.409 Section 779.409 Labor... Students, Learners, and Handicapped Workers § 779.409 Handicapped workers. Regulations have been issued... handicapped workers at wages lower than the minimum wage applicable under section 6 of the Act....

  13. Academic Goals and Self-Handicapping Strategies in University Students.

    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.

  14. Análise da correlação entre a escala visual-análoga e o Tinnitus Handicap Inventory na avaliação de pacientes com zumbido Correlation analysis of the visual-analogue scale and the Tinnitus Handicap Inventory in tinnitus patients

    Ricardo Rodrigues Figueiredo


    Full Text Available Um dos tópicos mais questionado nos estudos clínicos sobre zumbido é o método de mensuração do mesmo. As Escalas Visual-Análogas (EVAs e o Tinnitus Handicap Inventory (THI são freqüentemente utilizados para este fim. OBJETIVO: Verificar a correlação entre os escores da EVA e do THI em pacientes com zumbido neurossensorial através de um estudo prospectivo. MATERIAL E MÉTODO: 43 pacientes com zumbido neurossensorial quantificaram o zumbido pelos dois métodos, sendo os escores comparados através do Coeficiente de Relação de Spearman. RESULTADOS: Foi observada correlação entre os escores da EVA e do THI. CONCLUSÃO: Em pacientes com zumbido neurossensorial existe correlação entre os escores da EVA e do THI.One of the most challenging topics in tinnitus clinical studies is the measuring method used. Visual Analogue Scales (VAS and Tinnitus Handicap Inventory (THI are frequently used in tinnitus. AIM: To verify the relationship between VAS and THI scores in tinnitus patients in a prospective study. MATERIALS AND METHODS: 43 patients classified their tinnitus according to VAS and THI, and both scores were compared through the Spearman's correlation coefficient test. RESULTS: There was a correlation between the VAS and THI scores. CONCLUSION: There is correlation between VAS and THI scores in patients with sensorineural tinnitus.

  15. The Handicapped Can Dance Too!

    Lloyd, Marcia L.


    A program of dance therapy activities can offer handicapped individuals positive experiences in such areas as body image, spatial awareness, self-confidence, hand-eye/foot-eye coordination, visual focusing, balance and social relations. (Author/MJB)

  16. Patient Safety Culture in Nephrology Nurse Practice Settings: Initial Findings.

    Ulrich, Beth; Kear, Tamara


    Patient safety culture has been studied in many practice settings, but there is a dearth of information on the culture of safety in nephrology nurse practice settings. This research study employed the use of an online survey to assess patient safety cultures in nephrology nurse practice settings. The survey was created using items from two Agency for Healthcare Research and Quality (AHRQ) survey assessment tools--the Hospital Survey on Patient Safety Culture and the Medical Office Survey on Patient Safety Culture. Select items from these tools were combined to address the safety of care delivered in hospital and outpatient nephrology nurse practice settings. Almost 1,000 nephrology nurses responded to the survey. Analysis of results and comparison with AHRQ comparative data found high ratings for teamwork, but indicted a continued needfor additional education and attention related to hand hygiene, medication administration safety, communication, and prioritization in nephrology practice settings. Nurses in all nephrology nurse practice settings need to routinely assess and positively contribute to the culture of patient safety in their practice settings, and lead and engage in efforts to ensure that patients are safe.

  17. [The concept of handicap].

    Hamonet, C; Magalhaes, T


    The notion of disability appears recently in the medical and medico-legal field. It is the origin of a fundamental discussion about the health, and an ethical debate about human person. Indeed it drives to identify among the health users a particular group: disabled persons for whom the methods used with success in the field of diseases are not convenient. For ethical point of view: it is the identity of the person in a situation of disability, its dignity, its self-esteem and the respect through the regard of others which are in question. The debate was amplified when the project of a classification of handicap, as consequences of diseases, (Wood, WHO) was published, in 1980. Two tendencies were in opposition: one of them is "medicinal", following the opinion of Wood, the second is "anthropological and social", supported by scientific and disabled associations. The first proposition of Wood, after a long discussion, is abandoned. It is replaced by a "Classification of functioning, disability and health", adopted by the Mondail assembly of WHO in May 2002. This device is a compromise between the precedent tendencies. This document is heavy, confusing, imprecise and very difficult to use. We suggest a definition with dimensions, separating clearly the body modifications, the universal functional capacities for a human person and the situations of life. The subjectivity is individualised as a special dimension of assessment.

  18. Voice handicap index in Swedish.

    Ohlsson, Ann-Christine; Dotevall, Hans


    The objective of this study was to evaluate a Swedish version of the voice handicap index questionnaire (Sw-VHI). A total of 57 adult, dysphonic patients and 15 healthy controls completed the Sw-VHI and rated the degree of vocal fatigue and hoarseness on visual analogue scales. A perceptual voice evaluation was also performed. Test-retest reliability was analyzed in 38 subjects without voice complaints. Sw-VHI distinguished between dysphonic subjects and controls (P 0.84) and test-retest reliability (intraclass correlation coefficient >0.75) were good. Only moderate or weak correlations were found between Sw-VHI and the subjective and perceptual voice ratings. The data indicate that a difference above 13 points for the total Sw-VHI score and above 6 points for the Sw-VHI subscales is significant for an individual when comparing two different occasions. In conclusion, the Sw-VHI appears to be a robust instrument for assessment of the psycho-social impact of a voice disorder. However, Sw-VHI seems to, at least partly, capture different aspects of voice function to the subjective voice ratings and the perceptual voice evaluation.

  19. Social acceptance of handicapped people in Mongolia

    Jargalmaa Bayarsaikhan


    Full Text Available The social integration of people with handicaps is an important social task. Their equal participation in social life cannot only be reached by law, but the acceptance of the social environment is an essential basic condition. Experiences, attitudes and behaviours of non-handicapped people towards people with handicaps are very important. The situation of people with handicaps has been confronted with a lack of understanding prejudices and refusal up to today. This study investigates how the mongolian citizens think about handicapped people. The adults were asked about subjects like social acceptance, refusal or even depreciation of people with handicaps.

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

    Ottosen, B; Pedersen, B D


    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...... delivery of a baby and wound treatment following caesarean section. Some patients were embarrassed due to the appearance and smell of the exudate. CONCLUSION: Use of NPWT clearly influences patients' daily life. Patients have a feeling of being dependent on and attached to the equipment...

  1. Patient engagement in the inpatient setting: a systematic review.

    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

  2. Handicap og ligebehandling i praksis

    Bonfils, Inge Storgaard; Bengtsson, Steen; Olsen, Leif

    Handicap er et af de områder, hvor den sociale indsats har været stigende gennem mange år. Flere forskellige professionsgrupper, som socialrådgivere, pædagoger, ergoterapeuter og fysioterapeuter arbejder med området, og derfor er der behov for, at de fagprofessionelle – både igennem deres...... uddannelsesforløb og efterfølgende – opnår viden om emnet handicap og ligebehandling. Med denne antologi sætter vi fokus på ligebehandling. Undersøgelser har vist, at kun få af de offentligt ansatte, der har ansvaret for indsatsen i forhold til handicap, har viden om dansk handicappolitik og dens principper....

  3. Teaching Moderately Handicapped Students to Play Tee-Ball.

    Swenson-Pierce, Ann; Kohl, Frances L.


    A tee-ball training program was implemented in an integrated educational setting to provide two moderately handicapped elementary students with a wide range of age-appropriate leisure activities. Possible adaptations are described in terms of playing space, skill sequence, rules, and materials. (CL)

  4. The handicap principle and the argument of subversion from within

    Baron, Christian


    This paper examines the very disparate positions that various actors have taken towards the argument of subversion from within (a classical argument against the evolution of altruism by group selection) in a set of related debates on group selection, altruism and the handicap principle. Using thi...

  5. Museums and Handicapped Students: Guidelines for Educators.

    Smithsonian Institution, Washington, DC. National Air And Space Museum.

    Presented are guidelines drawn from surveys of programs and services provided for handicapped persons in U.S. museums. An initial section which reviews literature on museum programs for handicapped visitors focuses on problems and misconceptions regarding blind, deaf, physically handicapped, learning disabled and emotionally disturbed, and…

  6. Innovative Methods for Serving Rural Handicapped Children.

    Latham, Glenn; Burnham, Julia


    Some innovative methods of serving the rural handicapped population are described: volunteers; telecommunications for home instruction; SPECIALNET electronic mail; and resources for parents. Three cases involving Utah's Cooperative Extension Project for the Handicapped summarize services for handicapped and Indian students. (GDC)

  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. Ouderlijke mediasocialisatie : hulpbron of handicap?

    Notten, Natascha; kraaykamp, Gerbert; Ultee, Wout


    Summary Media socialization: help or handicap? A study of the long term effects of parental media socialization on children’s educational success In this article we analyzed the long term effects of parental media socialization on educational success. We employed information on 7838 individuals from

  9. Assessment Strategies for the Handicapped.

    Guidubaldi, John; And Others


    This review of assessment strategies for handicapped populations is intended to provide counselors with assessment perspectives as well as specific suggestions. The review emphasizes the counselor's role as a member of a diagnostic team and the need to consider a variety of information in formation of meaningful intervention strategies. (Author)

  10. Patient-guided counseling in the community pharmacy setting.

    Barnett, C W; Nykamp, D; Ellington, A M


    To test a new prescription counseling method termed "patient-guided counseling" (PGC) in community pharmacies. Post-test experimental design in which subjects were randomized to three groups. Six community pharmacies (three chain and three independent). Patients presenting new prescriptions. Patients were randomly assigned to one of three comparison groups. The PGC group was given a written prompt instructing them to write any questions they wished to ask about their prescription or their medical condition. The pharmacist then incorporated these questions into the subsequent verbal counseling. A second group was given a written prompt encouraging them to ask the pharmacist questions. This was followed by customary verbal counseling. A third group served as the control. No prompts were provided, but the pharmacist did provide customary verbal counseling. Patients' demographics, recall of medication information, and satisfaction with counseling. Patients were contacted by telephone 5 days after the start of drug therapy to measure compliance. Pharmacists rated their satisfaction with the information communicated and with their interactions with patients. Compared with customary verbal counseling, the PGC method was associated with more supplemental questions asked by the patient. Compared with the other two methods, PGC was associated with greater pharmacist satisfaction with the information communicated and slightly longer counseling sessions. No significant differences were found for patients' overall satisfaction with counseling, recall of information, and compliance. In the community pharmacy setting, PGC fosters patient participation in medication counseling, a necessary element for the provision of pharmaceutical care.

  11. Validation of the Italian Voice Handicap Index-10.

    Forti, Stella; Amico, Marianna; Zambarbieri, Annamaria; Ciabatta, Annaclara; Assi, Cristiana; Pignataro, Lorenzo; Cantarella, Giovanna


    Time consuming is an important aspect in assessing dysphonic patients. So, the English version of the Voice Handicap Index (VHI-30), a self-administered questionnaire consisting of 30 items used to evaluate patients' self-perception of voice problems, was reduced to 10 items (VHI-10) for clinical purposes. In 2010, an Italian version of VHI-30 was validated, now the aims of this study were to analyze the psychometric properties of an Italian version of VHI-10 and to evaluate its validity in a cohort of patients affected by organic or functional dysphonia. Cross-sectional study. The Italian version of the VHI-30 was submitted to 372 dysphonic participants and 120 healthy control subjects and was conducted again 2 weeks later. The 10 items constituting the VHI-10 were extracted from the VHI-30. For 73 dysphonic patients, the questionnaire was also administered after treatment. The scores of the control group were significantly lower with respect to all diagnostic subgroups (PItalian VHI-10. The ratio of the VHI-10 and VHI-30 scores was higher than 0.333 in all subgroups. This study demonstrated that the Italian VHI-10 is a robust tool that can adequately represent and replace the VHI-30. The reported results support the use of the VHI-10 for the Italian population in clinical settings owing to its validity and rapid and simple use. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  12. Quality and Patient Safety Teams in the Perioperative Setting.

    Serino, Michele Fusco


    Quality and patient safety teams in the perioperative setting can provide perioperative personnel with a safety net to prevent avoidable errors, which is a necessity in today's complex surgical world. The primary goal of the quality and patient safety team should be to develop and implement a perioperative quality and patient safety strategic plan. The mission of the plan can be developed by surveying facility employees, choosing a quality methodology, and using an evidence-based approach to develop and implement quality programs and processes. To create and sustain a quality and patient safety team, it is important to select a heterogeneous group; define team roles; identify day-to-day, weekly, and monthly team responsibilities; actively participate in facility committees, meetings, and new employee orientation; conduct audits; and schedule project time.

  13. Priority Settings in patients with Chronic Diseases and Cancer

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

    datasets: 1) video recordings of consultations in general practice, 2) semi-structured interviews with patients who have a chronic disease and who have recently finished primary treatment for a non-metastatic cancer, 3) semi-structured interviews with general practitioners. Video recordings......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...... cancer treatment, where patients are transitioning to survivorship, might be a vulnerable time. Uncertainty about health status, physical- and emotional symptoms from cancer disease and treatment, and perhaps uncertainty about which doctor to consult, might influence patients’ priorities and attention...

  14. Environmental qualities and patient wellbeing in hospital settings

    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...... be linked to such spatial qualities, like stress and depression. In other words, the application of this categorisation foregrounds the importance and the convenience of looking at spatial qualities of the physical environment, when addressing issues related to patient or staff wellbeing. Abstract DK...

  15. [Essential data set's archetypes for nursing care of endometriosis patients].

    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.

  16. Identifying and managing patients with delirium in acute care settings.

    Bond, Penny; Goudie, Karen


    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  17. 28 CFR 41.32 - Qualified handicapped person.


    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Qualified handicapped person. 41.32..., NONDISCRIMINATION ON THE BASIS OF HANDICAP IN FEDERALLY ASSISTED PROGRAMS Standards for Determining Who Are Handicapped Persons § 41.32 Qualified handicapped person. Qualified handicapped person means: (a) With...

  18. Objective Voice Parameters and Self-Perceived Handicap in Dysphonia

    Hummel, Christina; Scharf, Manuela; Schützenberger, Anne; Graessel, Elmar; Rosanowski, Frank


    Objective: This study focuses on the relation between objective voice quality and the self-perception of a voice handicap. Patients and Methods: The study group consisted of 86 German-speaking patients (51 women, 35 men) suffering from benign dysphonia. The test persons completed the German version of the Voice-Related Quality of Life (V-RQOL) Questionnaire without prior information about their diagnosis and underwent voice analysis with the Dysphonia Severity Index (DSI) being the parameter ...

  19. Customer care. Patient satisfaction in the prehospital setting.

    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

  20. 45 CFR 84.34 - Educational setting.


    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Educational setting. 84.34 Section 84.34 Public... Secondary Education § 84.34 Educational setting. (a) Academic setting. A recipient to which this subpart... handicapped person. A recipient shall place a handicapped person in the regular educational...

  1. 7 CFR 15b.23 - Educational setting.


    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Educational setting. 15b.23 Section 15b.23 Agriculture... Education § 15b.23 Educational setting. (a) Academic setting. A recipient to which this subpart applies... handicapped person. A recipient shall place a handicapped person in the regular educational...

  2. 45 CFR 605.34 - Educational setting.


    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Educational setting. 605.34 Section 605.34 Public..., Elementary, and Secondary Education § 605.34 Educational setting. (a) Academic setting. A recipient to which... needs of the handicapped person. A recipient shall place a handicapped person in the regular...

  3. The handicap principle and the argument of subversion from within.

    Baron, Christian


    This paper examines the very disparate positions that various actors have taken towards the argument of subversion from within (a classical argument against the evolution of altruism by group selection) in a set of related debates on group selection, altruism and the handicap principle. Using this set of debates as a case study, this paper argues that different applications of epistemic values were one of the factors behind the disagreements between John Maynard Smith and Amotz Zahavi over a number of important evolutionary issues. The paper also argues that these different applications were connected to important epistemological differences related in part (but not solely) to their disciplinary background. Apart from conflicting evolutionary views concerning the theoretical feasibility of the handicap effect, these antagonists both differed in the confidence they ascribed to mathematical modeling and over the hereditary basis for altruistic behavior.

  4. Psychological distress longitudinally mediates the effect of vertigo symptoms on vertigo-related handicap.

    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.

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

    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.

  6. Inter-relationship of intelligence-quotient and self-concept with dental caries amongst socially handicapped orphan children

    PKS Virk


    Full Text Available Context : India has been the focus of many health surveys among normal, physically, and mentally handicapped children. However, the data, concerning oral health conditions of socially handicapped children living in orphanages, are scanty. Aims: To study the effect of parental inadequacy, environmental deprivation, and emotional disturbances on dental caries through intelligence quotient (IQ and self-concept in orphan children and also to co-relate dental caries with different levels of IQ and self-concept. Settings and Design: The study was carried out amongst socially handicapped children living in orphanages. Patients and Methods: 100 children in the age group of 10-14 years from orphanages were selected. Malin′s Intelligence Scale for Indian Children (MISIC was used to assess the intelligence quotient; self-concept questionnaire to assess self-concept of the child and recording of dental caries status of children was done as per WHO Index (1997. StatisticaL Analysis Used : To assess the relationship of dental caries with IQ, student′s unpaired t-test was used and; to find the relationship between self-concept and dental caries, Karl-Pearson′s coefficient of co-relation was applied. Results: the children in orphanages had a lower IQ and high caries experience but had an above average self-concept. There was also no co-relation between dental caries and self-concept. Conclusions: Orphan children, being socially handicapped, are at an increased risk for dental caries due to a lower IQ level, parental deprivation, and institutionalization. Moreover, lack of co-relation between dental caries and self-concept could be explained by the fact that dental caries is a lifelong process whereas different dimensions of self-concept are in a state of constant flux.

  7. Patient Safety Culture in Nephrology Nurse Practice Settings: Results by Primary Work Unit, Organizational Work Setting, and Primary Role.

    Ulrich, Beth; Kear, Tamara


    Patient safety culture is critical to the achievement of patient safety. In 2014, a landmark national study was conducted to investigate patient safety culture in nephrology nurse practice settings. In this secondary analysis of data from that study, we report the status of patient safety culture by primary work unit (chronic hemodialysis unit, acute hemodialysis unit, peritoneal dialysis unit) and organizational work setting (for-profit organization, not-for-profit organization), and compare the perceptions of direct care nurses and managers/administrators on components of patient safety culture.

  8. Minimum Competency Testing and the Handicapped.

    Wildemuth, Barbara M.

    This brief overview of minimum competency testing and disabled high school students discusses: the inclusion or exclusion of handicapped students in minimum competency testing programs; approaches to accommodating the individual needs of handicapped students; and legal issues. Surveys of states that have mandated minimum competency tests indicate…

  9. Euthanasia of Severely Handicapped Infants: Ethical Issues.

    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…

  10. Educating the Handicapped in Biomedical Instrumentation

    Rosenbrier, Gilbert N.


    Handicapped community college students recruited for a one-year pilot career program (Biomedical Equipment Technology) proved that when architectual barriers are removed, educational and career fulfillment become possible. Innovations introduced to assist handicapped students now benifit every college student; new programs for paraplegics and the…

  11. The Handicapped Student: Problems and Perceptions.

    Penn, J. Roger; Dudley, David H.


    Handicapped college students view the attitudes of the nonhandicapped as the major barrier facing them. Other concerns include finding a rewarding career, architectual barriers and financial need. Faculty and students need to be aware of both the problems and contributions of the handicapped. (JAC)

  12. Speech Handicapped - Research: Exceptional Child Bibliography Series.

    Council for Exceptional Children, Reston, VA. Information Center on Exceptional Children.

    The bibliography, which is one of a series of over 50 similar selected bibliographies dealing with handicapped and gifted children, contains 100 references selected from Exceptional Child Education Abstracts pertaining to research with speech handicapped children. Bibliographic data, availability information, indexing and retrieval terms, and…

  13. Aurally Handicapped - Programs: Exceptional Child Bibliography Series.

    Council for Exceptional Children, Reston, VA. Information Center on Exceptional Children.

    The bibliography, one in a series of over 50 similar listings related to handicapped and gifted children, contains 89 references selected from Exceptional Child Education Abstracts dealing with programs for the aurally handicapped. Bibliographic data, availability information, indexing and retrieval descriptors, and abstracts are given for all…

  14. Handicap i beskæftigelsesindsatsen

    Kjeldsen, Lena; Amby, Finn


    Ledige med handicap er omfattet af de samme krav og tilbudsmuligheder som andre ledige. Først efter længere tids offentlig forsørgelse, kan særlige indsatser komme på tale. Det er overladt til de kommunale jobcentre, hvilken rolle handicap skal spille i beskæftigelsesindsatsen. Praksis på området...

  15. Calcineurin activity in children with Mental handicap.

    Bindu, L Hema; Rani, P Usha; Reddy, P P


    Calcineurin, a Ca(2+)-Calmodulin dependent protein phosphatase, is important for Ca(2+) mediated signal transduction. The main objective of this study was to examine the potential role of calcineurin in idiopathic mental handicap. Calcineurin levels were estimated in 20 children in the age group of 5-16 years with idiopathic mental handicap attending the Special. Education Centre for the Mentally Handicapped in Hyderabad. The results of the present study showed decreased activity of serum calcineurin in children with idiopathic mental handicap compared to those of normal subjects in the same age group. The observations thus suggest impaired calcineurin activity in children with mental handicap. Calcineurin that is involved in biosynthesis and release of neurotransmitters at the synaptic terminal brain is affected thereby causing brain damage and leading to mental handicap. Impaired calcineurin activity was already indicated in many human diseases such as Down's syndrome, Alzheimers, Brain ischemia, cardiac hypertrophy etc. It is therefore necessary to check the calcineurin levels in children with mental handicap to understand the role of calcineurin in the causation of Mental handicap.

  16. Teaching the Physically Handicapped to Swim.

    Anderson, William

    First principles of teaching swimming to the handicapped are reviewed; attention is given to children with cerebral palsy or muscular dystrophy, physical handicaps, blindness, and deafness. Swimming strokes, suggested exercises, group teaching, and a typical sequence of lessons and exercises are considered. Some case histories and a plan for a…

  17. Evaluating the non-English Speaking Handicapped.

    Fineman, Carol A.; Ross, Amparo

    The project titled "Evaluating the non-English Speaking Handicapped" was established to research existing evaluation instruments in language other than English, validate the tests as well as additional translations where needed, and develop a procedural manual for distribution to utilize in evaluating non-English speaking handicapped students. The…

  18. Euthanasia of Severely Handicapped Infants: Ethical Issues.

    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…

  19. A retrospective study concerning the psychosocial impact of voice disorders: Voice Handicap Index change in patients with benign voice disorders after treatment (measured with the Dutch version of the VHI).

    Bouwers, Frans; Dikkers, Frederik G


    The goal of this study was to gain better understanding of psychosocial effects of benign voice problems as measured with the Dutch version of the Voice Handicap Index (VHI). The effect of voice problems on daily life differs from person to person. Over the last few decades there has been a growing understanding of the fact that the psychosocial effect of this medical problem needs to be acknowledged. The VHI is a known voice specific Quality-of-Life measuring instrument, which is often used for this purpose. In the University Medical Center Groningen, Groningen, the Netherlands, patients with voice problems are analyzed at a Voice Clinic by a multidisciplinary team of voice specialists. In this study, we have analyzed patients with benign voice problems before and after treatment in the period of April 2004 to October 2006. The study group consisted of 68 patients (39 female). For comparison reason, we included a control group (n=68), matched for age and gender. The mean VHI score of the patient group before treatment was 48.9 (SD=20.9). After treatment, there was a significant improvement to 28.3 (SD=20.5) (PVHI scores of men and women. As could be expected, voice disorders of different etiology showed different VHI scores. Before and after treatment, the patient group showed a statistically significantly higher VHI score (PVHI score of 3.62, SD=3.82). Patients with different voice problems seem to have different results with the VHI. Treatment leads to statistically significant improvement in VHI scores. The VHI has proven to be a good instrument to evaluate the psychosocial consequences of voice problems.

  20. Voice handicap and health-related quality of life after treatment for small laryngeal carcinoma.

    Killguss, Helen; Gottwald, Frank; Haderlein, Tino; Maier, Andreas; Rosanowski, Frank; Iro, Heinrich; Psychogios, Georgios; Schuster, Maria


    Treatment of small carcinoma of the larynx may lead to voice handicap and restricted quality of life. The relationship between the two is revealed. Sixty-five patients aged 62.1 ± 10.0 years rated their voice handicap and quality of life after treatment of T1 (n = 35) or T2 (n = 30) laryngeal carcinoma during regular out-patient examinations. For the self-assessment of the voice, the Voice Handicap Index (VHI) and the disease-independent Short Form-36 Health Survery (SF-36) questionnaires were used. Voice handicap (total score 38.9 ± 26.0) did not differ in the two tested groups, T1 and T2, and the data of SF-36 (physical score 43.0 ± 10.7; mental score 50.2 ± 9.1) showed significant differences for the mental score. Patients rated their voice handicap worse than healthy persons did after treatment of laryngeal carcinoma. VHI and SF-36 data were strongly correlated. Voice handicap is significantly related to the quality of life, especially affecting the mental domain. Thus, the rehabilitation of voice disorders should have a beneficial impact on quality of life.

  1. The patient's perspective of the feasibility of a patient-specific instrument in physiotherapy goal setting: a qualitative study

    Stevens, A.; Moser, A.; Koke, A.; Weijden, T.T. van der; Beurskens, A.


    BACKGROUND: Patient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goal-setting process

  2. The patient's perspective of the feasibility of a patient-specific instrument in physiotherapy goal setting : a qualitative study

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


    Background: Patient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goal-setting process

  3. Patient satisfaction among Spanish-speaking patients in a public health setting.

    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 < .001). Results of logistic regression analyses indicated that, despite the availability of interpreters at all JCDH primary care centers, differences in satisfaction existed between Spanish and English 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.

  4. Development of the Arabic Version of Dysphagia Handicap Index (DHI).

    Farahat, Mohamed; Malki, Khalid H; Mesallam, Tamer A; Bukhari, Manal; Alharethy, Sami


    The Dysphagia Handicap Index (DHI) is a 25-item self-administered questionnaire. It is a noninvasive tool for measuring the handicapping effect of dysphagia on the physical, functional, and emotional aspects of people's lives. The purposes of the present study were to develop an Arabic version of the DHI and to evaluate its validity, consistency, and reliability in the normal Arabic population with oropharyngeal dysphagia. This was a prospective study that was carried out at the Communication and Swallowing Disorders Unit, King Saud University. The generated Arabic DHI was administered to 94 patients with oropharyngeal dysphagia and 98 control subjects. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared. The Arabic DHI showed excellent internal consistency (Cronbach's α = 0.95). Also, good test-retest reliability was found for the total scores of the Arabic DHI (r = 0.9, p = 0.001). There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (p DHI is a valid tool for self-assessment of the handicapping effect of dysphagia on the physical, functional, and emotional aspects of patients and can be used by Arabic language speakers.

  5. Development of bladder control in mentally handicapped children

    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.

  6. 45 CFR 1151.12 - Qualified handicapped person.


    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Qualified handicapped person. 1151.12 Section 1151... AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE ARTS NONDISCRIMINATION ON THE BASIS OF HANDICAP Standards for Determining Who Are Handicapped Persons § 1151.12 Qualified handicapped person....

  7. 49 CFR Appendix A to Part 609 - Elderly and Handicapped


    ... 49 Transportation 7 2010-10-01 2010-10-01 false Elderly and Handicapped A Appendix A to Part 609..., DEPARTMENT OF TRANSPORTATION TRANSPORTATION FOR ELDERLY AND HANDICAPPED PERSONS Pt. 609, App. A Appendix A to Part 609—Elderly and Handicapped The definitions of the term elderly and handicapped as applied...

  8. The Gifted-Visually Handicapped Child: A Review of Literature.

    Lin, Shang-Ping; Sikka, Anjoo

    This literature review examines and integrates research addressing visual handicap and giftedness and provides suggestions for the identification and education of gifted students with visual handicaps. The review addresses definitions of visual handicap and giftedness, characteristics of the gifted visually handicapped child, the problem of…

  9. The Italian version of the Mouth Handicap in Systemic Sclerosis scale (MHISS) is valid, reliable and useful in assessing oral health-related quality of life (OHRQoL) in systemic sclerosis (SSc) patients.

    Maddali Bongi, S; Del Rosso, A; Miniati, I; Galluccio, F; Landi, G; Tai, G; Matucci-Cerinic, M


    In systemic sclerosis (SSc), mouth and face involvement leads to problems in oral health-related quality of life (OHRQoL). Mouth Handicap in Systemic Sclerosis scale (MHISS) is a 12-item questionnaire specifically quantifying mouth disability in SSc, organized in 3 subscales. Our aim was to validate Italian version of MHISS, by assessing its test-retest reliability and internal and external consistency in Italian SSc patients. Forty SSc patients (7 dSSc, 33 lSSc; age and disease duration: 57.27 ± 11.41, 9.4 ± 4.4 years; 22 with sicca syndrome) were evaluated with MHISS. MHISS was translated following a forward-backward translation procedure, with independent translations and counter-translation. Test-retest reliability was evaluated, comparing the results of two administrations, with intraclass correlation coefficient (ICC). Internal consistency was assessed by Cronbach's α and external consistency by comparison with mouth opening. MHISS has a good test-retest reliability (ICC: 0.93) and internal consistency (Cronbach's α:0.99). A good external consistency was confirmed by correlation with mouth opening (rho: -0,3869, p: 0.0137). Total MHISS score was 17.65 ± 5.20, with scores of subscale 1 (reduced mouth opening) of 6.60 ± 2.85 and scores of subscales 2 (sicca syndrome) and 3 (aesthetic concerns) of 7.82 ± 2.59 and 3.22 ± 1.14. Total and subscale 2 scores are higher in dSSc than in lSSc. This result may be due to the higher presence of sicca syndrome in dSSc than in lSSc (p = 0.0109). Our results support validity and reliability in Italian SSc patients of MHISS, specifically measuring SSc OHRQoL.

  10. Patient Abuse in the Health Care Setting: The Nurse as Patient Advocate.

    Albina, Julie K


    Incidents of verbal and physical patient abuse in health care settings continue to occur, with some making headline news. Nurses have a professional and ethical responsibility to advocate for their patients when incidents of abuse occur. Tolerating or ignoring inappropriate behaviors occurs for multiple reasons, including ignorance, fear of retaliation, the need for peer acceptance, and concerns for personal advancement. Nurses need to reflect on their biases before they can truly respect patients' autonomy. Through the examination of reported cases of patient abuse, the need for a change in hospital culture becomes evident. The primary steps in eliminating patient abuse are opening communication, providing education, establishing competency, eliminating tolerance of unacceptable behavior, and creating a code of mutual respect. A change in culture to one of mutual respect and dignity for staff members and patients will lead to the best outcomes for all involved.

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

    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.

  12. The Holland Theory: Implications for the Handicapped.

    Cummings, Rhoda; Maddux, Cleborne D.


    The authors review John Holland's theory that career choice reflects individual personality and behavioral styles, as well as related research findings with nonhandicapped populations. They discuss implications of the theory's appropriateness for the handicapped. (SK)

  13. Preferential Education Policies for the Handicapped.

    Reich, Warren T.


    The author examines the issue of preferential education for the handicapped from the perspectives of ethics, civil rights, and theories of justice. This article is part of a theme issue on disabled persons. (SJL)

  14. Designing Instructional Activities for Young Handicapped Children.

    Kaczmarek, Louise A.; Dell, Amy Glasser


    Proposed are several new directions that encourage the variety and flexibility of haphazard teaching and the precision of one objective-one activity teaching in the design of activities for handicapped preschoolers. Journal availability: see EC 133 846. (Author)

  15. Should Museums Serve the Visually Handicapped?

    Toll, Dove


    The National Museum of Natural History of the Smithsonian Institution undertook a research project to determine what could be done to enable visually handicapped persons to benefit from the museum's resources. (Author)

  16. The Representation of the Handicapped in Literature.

    Ogamo, Hideo

    The paper summarizes results from an analysis of 276 Japanese literary works which include the handicapped. Works dealing with the blind and haiku written by a poet with cerebral palsy are described. (CL)

  17. Consumer Education for the Mentally Handicapped

    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)

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

    Samuel G Smith

    Full Text Available OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

  19. Placing wireless tablets in clinical settings for patient education

    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.

  20. Patient agenda setting in respiratory outpatients: A randomized controlled trial.

    Early, Frances; Everden, Angharad Jt; O'Brien, Cathy M; Fagan, Petrea L; Fuld, Jonathan P


    Soliciting a patient's agenda (the reason for their visit, concerns and expectations) is fundamental to health care but if not done effectively outcomes can be adversely affected. Forms to help patients consider important issues prior to a consultation have been tested with mixed results. We hypothesized that using an agenda form would impact the extent to which patients felt their doctor discussed the issues that were important to them. Patients were randomized to receive an agenda form to complete whilst waiting or usual care. The primary outcome measure was the proportion of patients agreeing with the statement 'My doctor discussed the issues that were important to me' rated on a four-point scale. Secondary outcomes included other experience and satisfaction measures, consultation duration and patient confidence. There was no significant effect of agenda form use on primary or secondary outcomes. Post hoc exploratory analyses suggested possible differential effects for new compared to follow-up patients. There was no overall benefit from the form and a risk of detrimental impact on patient experience for some patients. There is a need for greater understanding of what works for whom in supporting patients to get the most from their consultation.

  1. 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

    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.

  2. Respiratory function in handicapped children.

    Ishida, C; Fujita, M; Umemoto, H; Taneda, M; Sanae, N; Tazaki, T


    The aim of this study was to evaluate respiratory function of severely handicapped children. Tidal volumes and respiratory rates were determined in a total of 130 children with different clinical motor abilities. Tidal volume of non-sitters (n = 39) was significantly lower than ambulators (n = 49) or sitters (n = 42) (p less than 0.01). There was no difference in respiratory rate among the three groups. Among 45 children whose vital capacity could be determined, the tidal volumes showed a significant correlation with vital capacity (r = 0.56, p less than 0.001). Among four children whose tidal volume was less than 200 ml and respiratory rate was more than 30 cpm, blood gas analysis revealed hypoxia in three of them. The tidal volumes, therefore, would be a useful guide to estimate respiratory functions. It was concluded that the respiratory function in a non-sitter with reduced tidal volume is impaired, and that preventive measures must be taken against respiratory infection.

  3. Learning Handicapped and Nonlearning Handicapped Female Juvenile Offenders: Educational and Criminal Profiles.

    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…

  4. A Retrospective Study Concerning the Psychosocial Impact of Voice Disorders : Voice Handicap Index Change in Patients With Benign Voice Disorders After Treatment (Measured With the Dutch Version of the VHI)

    Bouwers, Frans; Dikkers, Frederik G.


    The goal of this study was to gain better understanding of psychosocial effects of benign voice problems as measured with the Dutch version of the Voice Handicap Index (VHI). The effect of voice problems on daily life differs from person to person. Over the last few decades there has been a growing

  5. Protecting patient safety in resource-poor settings.

    Galadanci, Hadiza Shehu


    A crucial element in the delivery of high-quality health care is patient safety. The rate of adverse events among hospital patients is an indication of patient safety. A systematic review of in-hospital adverse events revealed the median incidence of adverse events as 9.2%; 7.4% were lethal and 43.5% preventable. All the studies in the systemic review were from developed countries, as research is lacking from developing countries. In 2012, data from 10 developing countries reported adverse events ranging from 2.5 to 18.4% per country; 30% were lethal and 83% preventable. This study places patient safety as one of the major concerns of the health policy agenda in developing countries. Human resources for health deficits in developing countries constitute a major structural constraint for ensuring patient safety. The key to reducing adverse events in health care is system-based interventions rather than clinical interventions or technologies. Patient safety skills training, effective communication, and good team work are essential in improving patient safety in developing countries. Research on patient safety is needed to address the knowledge gap in developing countries.

  6. Communication between simulated patients and nurses in an oncology setting.

    Kruyver, I.; Kerkstra, A.; Bensing, J.; Wiel, H. van de; Holtkamp, C.; Wind, R.


    Introduction. From literature, it is well known that communication between health care providers and cancer patients is complicated by emotional issues. In this study, we investigated the communication skills of ward nurses during interactions with simulated cancer patients. This study is part of a

  7. Behavioral Analytic Approach to Placement of Patients in Community Settings.

    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…

  8. The handicap principle and the argument of subversion from within

    Baron, Christian


    connected to important epistemological differences related in part (but not solely) to their disciplinary background. Apart from conflicting evolutionary views concerning the theoretical feasibility of the handicap effect, these antagonists both differed in the confidence they ascribed to mathematical...... this set of debates as a case study, this paper argues that different applications of epistemic values were one of the factors behind the disagreements between John Maynard Smith and Amotz Zahavi over a number of important evolutionary issues. The paper also argues that these different applications were...

  9. Estimation of the patient monitor alarm rate for a quantitative analysis of new alarm settings.

    de Waele, Stijn; Nielsen, Larry; Frassica, Joseph


    In many critical care units, default patient monitor alarm settings are not fine-tuned to the vital signs of the patient population. As a consequence there are many alarms. A large fraction of the alarms are not clinically actionable, thus contributing to alarm fatigue. Recent attention to this phenomenon has resulted in attempts in many institutions to decrease the overall alarm load of clinicians by altering the trigger thresholds for monitored parameters. Typically, new alarm settings are defined based on clinical knowledge and patient population norms and tried empirically on new patients without quantitative knowledge about the potential impact of these new settings. We introduce alarm regeneration as a method to estimate the alarm rate of new alarm settings using recorded patient monitor data. This method enables evaluation of several alarm setting scenarios prior to using these settings in the clinical setting. An expression for the alarm rate variance is derived for the calculation of statistical confidence intervals on the results.

  10. Vocal effort and voice handicap among teachers.

    Sampaio, Márcio Cardoso; dos Reis, Eduardo José Farias Borges; Carvalho, Fernando Martins; Porto, Lauro Antonio; Araújo, Tânia Maria


    The relationship between voice handicap and professional vocal effort was investigated among teachers in a cross-sectional study of census nature on 4496 teachers within the public elementary education network in Salvador, Bahia, Brazil. Voice handicap (the outcome of interest) was evaluated using the Voice Handicap Index 10. The main exposure, the lifetime vocal effort index, was obtained as the product of the number of years working as a teacher multiplied by the mean weekly working hours. The prevalence of voice handicap was 28.8% among teachers with high professional vocal effort and 21.3% among those with acceptable vocal effort, thus yielding a crude prevalence ratio (PR) of 1.36 (95% confidence interval [CI]=1.14-1.61). In the final logistic model, the prevalence of voice handicap was statistically associated with the professional vocal effort index (PR=1.47; 95% CI=1.19-1.82), adjusted according to sex, microphone availability in the classroom, excessive noise, pressure from the school management, heartburn, and rhinitis.

  11. The new role of patients in future health settings.

    Ruotsalainen, Pekka; Blobel, Bernd


    Health is wide concept covering a person's physical, mental and social well-being. Traditionally, regulated healthcare has been the main source for curative and preventive service offered to patients. Healthcare is in transition, however. Paradigms such as patient empowerment and patient in the centre as well as in-home care service are changing processes and locations healthcare services are offered. Parallel to healthcare, new service models such as pHealth, ubiquitous healthcare, and digital medicine are developing. In the near future, technology enables the creation of a personal digital health dossier (e.g. digital patient and virtual patient model) for any individual. This dossier is stored and used in the unsecure information space. This all means that the traditional paternalistic patient model where patient is a passive object for regulated healthcare services will not work in future pHealth and digital health anymore. Instead, the new patient role (e.g. pHealth user or health consumer role) is dynamic, context-aware and participatory. The pHealth user can also have many roles at the same time, such as the role of informed chooser, decision maker, and personal health coordinator. This requires that the pHealth user can make information-based meaningful decisions before starting to use health services, and that he or she can trust on service providers by having evidence-based and reliable information about the quality and health impact of the services offered. A big challenge is that pHealth and digital health take place in unsecure information space where current healthcare specific laws, regulations, and medical ethics are insufficient to guarantee users' autonomy and privacy as well as the application of fair information and ethical principles when processing personal health information. A new ethical, legal and technical framework is needed. One of the prerequisites successful pHealth and digital health has to meet is the possibility to create

  12. Patient's Knowledge and Attitude towards Tuberculosis in an Urban Setting.

    Tasnim, Saria; Rahman, Aminur; Hoque, F M Anamul


    Tuberculosis is a public health problem in Bangladesh. This cross-sectional study was conducted to assess knowledge of TB patients about symptoms, ways of transmission and treatment of tuberculosis, and their perception of the illness. Between March and August 2008, 762 adult TB patients were interviewed at selected DOTS centre of Dhaka city. Male and female distribution was 55.6% and 44.4%, respectively. One quarter of them were illiterate, and more than half had extended family and live in a congested situation. Night fever was the most common symptom known (89.9%), and 56% were aware that it could spread through sneezing/coughing. Television was mentioned as a source of information about TB. The majority expressed a helping attitude towards other TB patients. Although most of them were positive about getting family support, 46.6% mentioned discrimination of separate utensils for food or drink. About 50.5% expressed increased sadness, 39.8% had fear of loss of job/wedges, and 21.4% felt socially neglected. Along with drug treatment the psychosocial reactions of TB patients should be addressed at DOTS centers for better control of the disease.

  13. Supporting Integrated Healthcare Solutions with Patients in Home Settings

    Jørgensen, Daniel Bjerring


    : The state-of-the-art of how national ICT infrastructures are designed has been identified and problems of that approach discussed. The foundation for a patient centric home/local infrastructure, to integrate data using applications and data providing applications e.g. medical devices, has been developed...

  14. Jordanian teachers' perceptions of voice handicap.

    Marie, Basem S; Natour, Yaser S; Haj-Tas, Maisa A


    This study aimed to investigate if Jordanian school teachers perceive their voice as handicapped using the Voice Handicap Index (VHI)-Arab. The effect of teachers' age, gender, years of teaching, class taught, and education level on VHI was examined. A total of 289 teachers and a control group of 100 participants took part in the study. The teachers' group differed significantly from the control group in the physical, emotional, and functional subscales and the total score of the VHI-Arab. There was no significant difference among teachers in any of the three VHI subscales or total regarding gender, age, years of teaching experience, education level, and classes taught. Jordanian teachers have a strong perception of voice handicap. Thus, preventive and treatment vocal programs are strongly advised.

  15. Handicapped Infants and Euthanasia: A Challenge to Our Advocacy.

    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)

  16. Handicapped Infants and Euthanasia: A Challenge to Our Advocacy.

    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)

  17. Low trait self-control predicts self-handicapping.

    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.

  18. 45 CFR 84.55 - Procedures relating to health care for handicapped infants.


    ... disability organization, a practicing nurse, and other individuals. A suggested model ICRC is set forth in..., Welfare, and Social Services § 84.55 Procedures relating to health care for handicapped infants. (a... action to be taken to effect compliance, and its continuing opportunity to comply voluntarily. (f) Model...

  19. Entry to Exit. Identification, Monitoring and Tracking of Handicapped and Disadvantaged Students. Final Report.

    Primavera, Joanne M.

    In view of new federal guidelines, a project sought to write a procedure for identifying disadvantaged, handicapped, and/or nontraditional students and set up a monitoring system in the Renton Vocational Technical Institute. A literature review showed no practical tracking system had been published. The identification procedure developed included…

  20. Environmental qualities and patient wellbeing in hospital settings

    Frandsen, Anne Kathrine


    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....... Målet med litteraturstudiet var at udvikle et værktøj, der kunne give bygherrer og beslutningstagere med ansvar for byggeriet af de mange nye hospitaler i Danmark, et overblik over forskningen på feltet. Denne artikel søger at give et overblik over litteraturstudiets resultater. Dette gøres med...

  1. An Age and Body Mass Handicap for the Marathon

    Vanderburgh, Paul M.


    An age and body mass handicap has been previously developed and validated for the 5-kilometer (5K) run. The purpose of this study was to develop a similar handicap for the marathon but with a different age adjustment based on deviations from age group world best marathon times within each sex. The resulting handicap allowed finish time comparisons…

  2. 34 CFR 75.610 - Access by the handicapped.


    ... 34 Education 1 2010-07-01 2010-07-01 false Access by the handicapped. 75.610 Section 75.610... by a Grantee? Construction § 75.610 Access by the handicapped. A grantee shall comply with the Federal regulations on access by the handicapped that apply to construction and alteration of...

  3. 38 CFR 21.51 - Determining employment handicap.


    ... handicap. 21.51 Section 21.51 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS.... Chapter 31 Initial and Extended Evaluation § 21.51 Determining employment handicap. For the purposes of § 21.50, an employment handicap will be found to exist only if a CP or VRC determines that...

  4. 38 CFR 21.52 - Determining serious employment handicap.


    ... employment handicap. 21.52 Section 21.52 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... 38 U.S.C. Chapter 31 Initial and Extended Evaluation § 21.52 Determining serious employment handicap. (a) Requirements for determining serious employment handicap. For each individual who is found...

  5. 36 CFR 910.34 - Accommodations for the physically handicapped.


    ... physically handicapped. 910.34 Section 910.34 Parks, Forests, and Public Property PENNSYLVANIA AVENUE... § 910.34 Accommodations for the physically handicapped. (a) Every development shall incorporate features which will make the development accessible by the physically handicapped. The standards in the...

  6. Control study on hydrogen proton magnetic resonance spectrum between the patients with light cognitive handicap and the normal old men%氢质子磁共振波谱在轻度认知障碍早期诊断中的应用研究

    徐朝霞; 张学昕; 谢柏梅; 刘楠; 龚雪鹏; 李哲; 李惠民; 鲁靖


    Objective:To explore the function of hydrogen proton magnetic resonance spectrum (1H-MRS) of the seahorse area in the early diagnosis of light cognitive handicap. Methods:Metaboilic level of 27 patients with light cognitive handicap and 27 normal old men was detected with 1H-MRS to get the values of N-Acetyl aminosuccinic acid;aspartic acid/creatine, bilineurin/creatine, cyclohexanhexol/creatine after the images were processed and analyzed. Results:The value of N-Acetyl aminosuccinic acid;aspartic acid/creatine of the patients with light cognitive handicap was obviously lower than that of the normal old men (t=2.516;P<0.5), while the value of cyclohexanhexol/creatine was higher (t=-2.137;P<0.5). There was no obvious difference on the value of bilineurin/creatine between the patients with light cognitive handicap and the normal old men. Conclusion: 1H-MRS which can sensitively monitor the changes of the encephalo-metabolism, early and accurately diagnose the light cognitive handicap is an adjuvanticity checking method in imageology to diagnose the light cognitive handicap.%目的:探讨海马区域氢质子磁共振波谱(1H-MRS)在轻度认知功能障碍(MCI)早期诊断中的作用。方法:选取27例MCI患者和27名正常老人,并将其分为MCI组与正常对照组,运用1H-MRS技术检测海马区域的代谢水平,采用配套软件对图像进行处理,分析后得到N-乙酰天门冬氨酸、胆碱、肌醇和肌酸的值,并对其进行比较。结果:MCI组与正常对照组相比,N-乙酰天门冬氨酸与肌酸比值显著降低(t=2.516,P<0.05),而肌醇与肌酸比值增高(t=-2.137,P<0.05),MCI组和正常组的胆碱与肌酸比值水平无明显差异。结论:1H-MRS能敏感地监测脑内代谢的变化,可对MCI做出较早及较准确的诊断,是一种辅助性的影像学检查方法。

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

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


    . In community and health care settings, we found an association between infection with GII.4 and increasing age. Norovirus GII.4 predominated in patients ≥60 years of age and in health care settings. A larger proportion of children than adults were infected with NoV GII.3 or GII.P21. Susceptibility to No......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...... practitioner or outpatient clinic, inpatients, and patients from foodborne outbreaks) were used to determine genotype distribution in relation to age and setting. NoV GII.4 was more prevalent among inpatients than among patients in community settings or those who became infected during foodborne outbreaks...

  8. Handbook for Teaching Emotionally Handicapped Children.

    Silberman, Al

    The handbook is intended to assist school districts in Arizona establish effective educational programs for emotionally handicapped children. Information on policies for initiation, organization, and operation of programs is provided, as are recommendations for academic programing, use of ancillary personnel, and behavior management techniques.…

  9. Siblings of Handicapped Children: A Review.

    Lobato, Debra


    Research is critically reviewed and evaluated to determine if the presence of a handicapped child in a family uniquely affects the nonhandicapped siblings and to identify factors mediating the nature and power of those effects. In addition, projects involving sibling therapy, education, and training are described. (Author/CL)

  10. Counseling Handicapped Students: A Cognitive Approach.

    Bello, Gerald A.


    Sees handicapped students as responsive to and appreciative of counseling assistance, noting these students share basic ambitions and dreams of nonhandicapped peers. Recommends school counselors can use cognitive counseling principles in a systematic fashion to help students begin to learn cognitive strategies and rational beliefs resulting in a…

  11. Career Education and the Handicapped Person.

    Hoyt, Kenneth B.

    The implications of career education are considered for handicapped persons. It is explained that career education consists of all experiences for learning about work; and basic definitions are given for "work", "career", "vocation", "occupation", "leisure" and "education". Work as a basic human need and human right is discussed; and economic,…

  12. Aurally Handicapped - Research: Exceptional Child Bibliography Series.

    Council for Exceptional Children, Reston, VA. Information Center on Exceptional Children.

    Eighty-nine references, including research reports, texts, journal articles, and other research-related literature, are included in the bibliography on research concerning aurally handicapped children (both the deaf and the hard of hearing). The bibliography, containing bibliographic data, availability information, indexing and retrieval terms,…

  13. Information Booklet for the Handicapped. Revised Edition.

    University of Southern California, Los Angeles. Office of Handicapped Student Services.

    This handbook is prepared by the University of Southern California for its handicapped students. It contains a description of the facilities located on campus, including accessibility of buildings, restrooms, telephones, ramps, and designated parking spaces. Also included is a description of student services available and solutions to problems…

  14. Predictors of Choral Directors' Voice Handicap

    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. Employment of Handicapped People in Leisure Occupations.

    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,…


    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. 嗓音障碍指数对声带囊肿患者术后嗓音的自我评估%Self-Assessment of Postoperative Voice with Voice Handicap Index in Patients with Vocal Fold Cysts

    程贤宁; 刘庆伟; 陈奇志; 陈朱井


    Objective To evaluate the postoperative voice recovery with voice handicap index (VHI)in patients undergoing surgery under suspension micro-laryngoscope and fiber laryngo-scope for vocal fold cysts,and to verify the practicability of VHI.Methods Sixty patients with vocal fold cysts were treated with surgical resection under suspension micro-laryngoscope(micro-scope group,n=30)or fiber laryngoscope(fiberscope group,n=30).The postoperative voice re-covery was self-assessed by using VHI scale,including functional(F),physiological(P),emotional (E)and total(TVH)scores.Results The F,E and TVH scores significantly decreased in both groups 1 week after operation(P<0.05).The F,P,E and TVH scores significantly decreased in both groups 1 month after operation(P<0.05).Compared with microscope group,the F,P and TVH scores significantly increased in fiberscope group(P<0.05).Conclusion The VHI can sub-j ectively reflect the degree of voice disorders in patients with vocal fold cysts.Therefore,it can be used for preoperative assessment of the degree of voice disorders and postoperative evaluation of the therapeutic efficacy.%目的:探讨嗓音障碍指数(voicehandicap index,VHI)用于支撑显微喉镜和纤维喉镜治疗声带囊肿后嗓音恢复的评估,并验证 VHI的实用性。方法选取确诊为声带囊肿并接受手术切除的患者60例,其中在支撑显微喉镜下治疗30例(显微镜组),在纤维喉镜下治疗30例(纤维镜组),2组患者采用 VHI量表对手术前后的嗓音恢复进行自我评估,内容包括功能(F)、生理(P)、情感(E)及总分(TVH)评分。结果术后1周,2组 F、E、TVH 评分均较术前明显降低(P<0.05);术后1个月,2组 F、P、E、TVH 评分均较术前明显降低(P<0.05),纤维镜组 F、P、TVH评分高于显微镜组(P<0.05)。结论 VHI可主观反映患者的嗓音障碍程度,可用于治疗前对嗓音障碍程度的估计,治疗后效果评价。

  18. Item reduction of the Voice Handicap Index (VHI) based on European translations.

    Nawka, T.; Leeuw, de I.M.; DeBodt, M.; Guimaraes, I.; Holmberg, E.B.; Schindler, A.; Woisard, V.; Whurr, R.; Konerding, U.


    Objective: Constructing an internationally applicable short-scale of the Voice Handicap Index (VHI). Methods: Subjects were 1,052 patients with 5 different types of voice disorder groups from Belgium, France, Sweden, Germany, Italy, The Netherlands, Portugal, and the USA. Different 9- and 12-item su

  19. A Survey of the Elderly and Young Elderly Tinnitus Patients with Tinnitus Handicap Inventory%老年及老年前期耳鸣患者耳鸣残疾度量化表问卷评估

    赵素萍; 刘新颖; 赵阳; 冀飞; 周其友


    目的 研究老年前期及老年期患者的耳鸣对其情绪的影响,评估耳鸣残疾度,试图发现老年患者群中耳鸣的临床特征.方法 主诉耳鸣患者60例,其中男性37例,女性23例,平均年龄65.1±11.3岁.根据年龄将患者分为两组:老年组(60岁以上组)35例,男22例,女13例;老年前期组(49~59岁组)25例,男14例,女11例.使用问卷对患者进行病史调查和耳鸣残疾度量化评估.结果 在受调查患者中,78.3%(47/60)自觉有听力损失,2例使用助听器,8.3%(5/60)自诉有耳病史,38.3%(23/60)有噪声接触史,63.3%(38/60)伴发其他疾病,老年组伴发其他疾病的比例较高.60例患者中.耳鸣残疾1级38例,占63.3%,2级12例,占20%,3级5例,占8.3%,4级2例,占3.3%,5级3例,占5%.两组患者各自的分级构成无统计学差异(P=0.604).两组之间3类问题功能性(P=0.164)、情绪性(P=0.21 3)、灾难性(P=0.111)无统计学差异.结论 耳鸣所造成的主观影响在老年人群中很明显.对于老年及老年前期患者,加强针对耳鸣的心理和情绪性调节非常重要.%objective To study the influence of tinnitus on the emotions of the elderly and young elderly patients and to find out the clinical characteristics of tinnitus in elderly patients.Methods 60 patients with tinnitus were involved in the survey (37 males and 23 females). The mean age was 65.1 ± 11.3 years old. The patients were divided into two groups: the elderly group (older than 60 years old) including 35 patients (22 males and 13 females) and the young elderly group (49 to 59 years old) including 25 patients (14 males and 11 females). The medical histories of the patients were surveyed and the Tinnitus Handicap Inventory was used to measure the degree of tinnitus. Results Among the patients investigated, 78.3% of cases (47/60) complained of hearing loss and 2 cases worn hearing aids, 8.3%(5/60)reported ear disease history, 38.3% (23/60) reported a history of exposure to noise, and 63.3

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

    Meesters, Jorit; Hagel, Sofia; Klokkerud, Mari


    Objective: To make a cross-cultural comparison of the contents of rehabilitation goals of patients admitted for rehabilitation and to compare the contents with the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis, by linking......%) 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...... arthritis are related to all ICF components, with "Activities and Participation" being the most frequently addressed. The contents of the goals are, to a considerable extent, covered by the comprehensive ICF Core Set for RA, but additional evaluation is required before the ICF Core Set is used...

  1. A new foam for support of the physically handicapped.

    Koreska, J; Albisser, A M


    This article is intended to inform professionals in the fields of rehabilitation medicine and biomedical engineering of some of the more significant properities of Temper Foam, a new foam for support of the physically handicapped. The unique properties of this foam are explained in terms of its microstructure, illustrated by scanning electron micrographs and by mechanical tests using an Instron Materials Testing machine. Fourteen non-ambulatory patients with Duchenne muscular dystrophy are using this foam in custom-fitted contoured support systems. Normally, these children show increasing signs of discomfort and skin breakdown due to their inability to alternate areas of weight bearing and high local pressure such as the ischial tuberosities. In our support systems lined with Temper Foam these problems have completely dissappeared. We find that Temper Foam types T-36, T-38 and -41 are ideally suited for patients weighing up to 35 kg. T-41 may be used for patients weighing up to 70 kg.

  2. Influence of complaints and singing style in singers voice handicap.

    Moreti, Felipe; Ávila, Maria Emília Barros de; Rocha, Clara; Borrego, Maria Cristina de Menezes; Oliveira, Gisele; Behlau, Mara


    The aim of this research was to verify whether the difference of singing styles and the presence of vocal complaints influence the perception of voice handicap of singers. One hundred eighteen singing voice handicap self-assessment protocols were selected: 17 popular singers with vocal complaints, 42 popular singers without complaints, 17 classic singers with complaints, and 42 classic singers without complaints. The groups were similar regarding age, gender and voice types. Both protocols used--Modern Singing Handicap Index (MSHI) and Classical Singing Handicap Index (CSHI)--have specific questions to their respective singing styles, and consist of 30 items equally divided into three subscales: disability (functional domain), handicap (emotional domain) and impairment (organic domain), answered according to the frequency of occurrence. Each subscale has a maximum of 40 points, and the total score is 120 points. The higher the score, the higher the singing voice handicap perceived. For statistical analysis, we used the ANOVA test, with 5% of significance. Classical and popular singers referred higher impairment, followed by disability and handicap. However, the degree of this perception varied according to the singing style and the presence of vocal complaints. The classical singers with vocal complaints showed higher voice handicap than popular singers with vocal complaints, while the classic singers without complaints reported lower handicap than popular singers without complaints. This evidences that classical singers have higher perception of their own voice, and that vocal disturbances in this group may cause greater voice handicap when compared to popular singers.

  3. Simulating Category Learning and Set Shifting Deficits in Patients Weight-Restored from Anorexia Nervosa


    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

  4. Vismodegib persistence and discontinuation patterns in Greek patients from a real world setting.

    Soura, Efthymia; Plaka, Michaela; Chasapi, Vasiliki; Antoniou, Christina; Stratigos, Alexander


    Hedghehog pathway inhibitors have been successfully used for patients with locally advanced basal cell carcinomas. However, these treatments have been associated with various adverse events that may limit patient compliance. In this study, an association of patient and disease characteristics with drug compliance in a real clinical setting was made. 18 patients were included in the study. The average patient age was 78.39 years. The time that patients remained to treatment was, on average, 8.73 months. 72.2% of patients experienced at least one adverse event. At study cut-off, 11 out of 18 patients had discontinued treatment. The most common reason for discontinuation was reported "fatigue" from the treatment due to the type of AEs experienced (37.4%) and patient's choice after complete response achievement (30.8%). Factors that were associated with treatment discontinuation was: number of previous treatments, severity of AEs and patient age. © 2017 Wiley Periodicals, Inc.

  5. Examining the relationship between authenticity and self-handicapping.

    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.

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

    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

  7. Clustering of cardiovascular risk factors and hypertension control status among hypertensive patients in the outpatient setting



    Objective To investigate the status of the clustering of cardiovascular risk factors and hypertension control among hypertensive patients in the outpatient setting in China.Methods This multi-center cross-sectional study was carried out from June to December 2009.Study patients were consecutively recruited from 46

  8. Patients' perceptions of their roles in goal setting in a spinal cord injury regional rehabilitation program.

    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.

  9. Recognizing potential barriers to setting and achieving effective rehabilitation goals for patients with persistent pain.

    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.

  10. Norovirus epidemiology in community and health care settings and association with patient age, Denmark.

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


    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 practitioner or outpatient clinic, inpatients, and patients from foodborne outbreaks) were used to determine genotype distribution in relation to age and setting. NoV GII.4 was more prevalent among inpatients than among patients in community settings or those who became infected during foodborne outbreaks. In community and health care settings, we found an association between infection with GII.4 and increasing age. Norovirus GII.4 predominated in patients ≥ 60 years of age and in health care settings. A larger proportion of children than adults were infected with NoV GII.3 or GII.P21. Susceptibility to NoV infection might depend on patient age and infecting NoV genotype. Cohort studies are warranted to test this hypothesis.

  11. Tools for measuring patient safety in primary care settings using the RAND/UCLA appropriateness method.

    Bell, Brian G; Spencer, Rachel; Avery, Anthony J; Campbell, Stephen M


    The majority of patient contacts occur in general practice but general practice patient safety has been poorly described and under-researched to date compared to hospital settings. Our objective was to produce a set of patient safety tools and indicators that can be used in general practices in any healthcare setting and develop a 'toolkit' of feasible patient safety measures for general practices in England. A RAND/UCLA Appropriateness Method exercise was conducted with a panel of international experts in general practice patient safety. Statements were developed from an extensive systematic literature review of patient safety in general practice. We used standard RAND/UCLA Appropriateness Method rating methods to identify necessary items for assessing patient safety in general practice, framed in terms of the Structure-Process-Outcome taxonomy. Items were included in the toolkit if they received an overall panel median score of ≥ 7 with agreement (no more than two panel members rating the statement outside a 3-point distribution around the median). Of 205 identified statements, the panel rated 101 as necessary for assessing the safety of general practices. Of these 101 statements, 73 covered structures or organisational issues, 22 addressed processes and 6 focused on outcomes. We developed and tested tools that can lead to interventions to improve safety outcomes in general practice. This paper reports the first attempt to systematically develop a patient safety toolkit for general practice, which has the potential to improve safety, cost effectiveness and patient experience, in any healthcare system.

  12. Total hip arthroplasty in an outpatient setting in 27 selected patients.

    Hartog, Yvon M den; Mathijssen, Nina M C; Vehmeijer, Stephan B W


    As a result of introduction of a fast-track program, length of hospital stay after total hip arthroplasty (THA) decreased in our hospital. We therefore wondered whether THA in an outpatient setting would be feasible. We report our experience with THA in an outpatient setting. In this prospective cohort study, we included 27 patients who were selected to receive primary THA in an outpatient setting between April and July 2014. Different patient-reported outcome measures (PROMs) were recorded preoperatively and at 6 weeks and 3 months postoperatively. Furthermore, anchor questions on how patients functioned in daily living were scored at 6 weeks and 3 months postoperatively. 3 of the 27 patients did not go home on the day of surgery because of nausea and/or dizziness. The remaining 24 patients all went home on the day of surgery. PROMs improved substantially in these patients. Moreover, anchor questions on how patients functioned in their daily living indicated that the patients were satisfied with the postoperative results. 1 re-admission occurred at 11 days after surgery because of seroma formation. There were no other complications or reoperations. At our hospital, with a fast-track protocol, outpatient THA was found to be feasible in selected patients with satisfying results up to 3 months postoperatively, without any outpatient procedure-specific complications or re-admissions.

  13. Survival, momentum, and things that make me "me": patients' perceptions of goal setting after stroke.

    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.

  14. A Handy EEG Electrode Set for patients suffering from altered mental state.

    Lepola, Pasi; Myllymaa, Sami; Töyräs, Juha; Hukkanen, Taina; Mervaala, Esa; Määttä, Sara; Lappalainen, Reijo; Myllymaa, Katja


    Although electroencephalography (EEG) is an important diagnostic tool for investigating patients with unexplained altered mental state (AMS), recording of emergency EEG is not a clinical routine. This is mainly due to the cumbersome electrode solutions. A Handy EEG Electrode Set consists of ten EEG, two EOG, two ground and two commutative reference hydrogel-coated silver wire electrodes attached to a thin polyester carrier film. The clinical usefulness of the Handy EEG Electrode Set was tested in 13 patients (five females, eight males) with AMS. EEG recordings were conducted at the same time with a standard 10-20 electrode set. The registration in the first patient case without the behind-ear electrodes (T9 and T10), indicated that these electrodes are very crucial to provide clinically relevant information from posterior regions of brain. In following 12 cases, the sensitivity and specificity for detecting EEG abnormality based on the Handy EEG Electrode Set recordings were 83 and 100 %, respectively. The Handy EEG Electrode Set proved to be easy to use and to provide valuable information for the neurophysiological evaluation of a patient suffering from AMS. However, further studies with larger number of patients are warranted to clarify the true diagnostic accuracy and applicability of this approach.

  15. Exploration of a reasonable dialysate temperature setting in hemodialysis for patients with hypertension

    Lin-Fang Xu; Chun-Lei Wu; Hong-Mei Sun; Tong-Qiang Liu


    Objective: This study aims to investigate the effect of 4 different dialysate temperatures on blood pressure during hemodialysis for patients with hypertension. Methods: Using a self-controlled method, the patients' body temperature was set as T. Accordingly, the dialysate temperature was set as 37 ℃, Tþ0.5 ℃, T, and T-0.5 ℃. The changes in blood pressure, heart rate, mean arterial pressure and dialysis-induced adverse reactions at the 4 different dialysate temper-atures were consistently monitored. Results: Patients who received hemodialysis with 37 ℃ and Tþ0.5 ℃ dialysate demonstrated an un-stable blood pressure and a higher incidence of adverse reactions. Patients who received hemodialysis with T and T-0.5 ℃ dialysate showed a relatively stable blood pressure, heart rate, and mean arterial pressure during dialysis. In particular, dialysate at T-0.5 ℃ resulted in the most stable blood pressure, the fewest adverse reactions and the best self-assessed comfort scores (P Conclusions: The dialysate temperature during hemodialysis for patients with hypertension should be set to a temperature based on patients' preoperative body temperate T or 0.5 ℃ below T. This practice is suggested to enhance the stability of patients' blood pressure and heart rate during hemodialysis, reduce complications and improve patients' tolerance of hemodialysis.

  16. Treatment goal setting for complex patients: protocol for a scoping review

    Grudniewicz, Agnes; Nelson, Michelle; Kuluski, Kerry; Lui, Vincci; Cunningham, Heather V; X Nie, Jason; Colquhoun, Heather; Wodchis, Walter P; Taylor, Susan; Loganathan, Mayura; Upshur, Ross E


    Introduction An increasing number of people are living longer with multiple health and social care needs, and may rely heavily on health system resources. When dealing with multiple conditions, patients, caregivers and healthcare providers (HCPs) often experience high treatment burden due to unclear care trajectories, a myriad of treatment decisions and few guidelines on how to manage care needs. By understanding patient and caregiver priorities, and setting treatment goals, HCPs may help improve patient outcomes and experiences. This study aims to examine the extent and nature of the literature on treatment goal setting in complex patients, identify gaps in evidence and areas for further inquiry and guide a research programme to develop definitions, measures and recommendations for treatment goal setting. Methods and analysis This study protocol outlines a scoping review of the peer reviewed and the grey literature, using established scoping review methodology. Literature will be identified using a multidatabase and grey literature search strategy developed by two librarians. Papers and reports on the topic of goal setting that address complexity or complex patients will be included. Results of the search will be screened independently by two reviewers and included studies will be abstracted and charted in duplicate. Ethics and dissemination Ethics approval is not required for this scoping review. Working with the knowledge users on the team, we will prepare educational materials and presentations to disseminate study findings to HCPs, caregivers and patients, and at relevant national and international conferences. Results will also be published in a peer-reviewed journal. PMID:27225653

  17. Comparing nursing handover and documentation: forming one set of patient information.

    Johnson, M; Sanchez, P; Suominen, H; Basilakis, J; Dawson, L; Kelly, B; Hanlen, L


    The aim of this study was to explore the potential for one set of patient information for nursing handover and documentation. Communication of patient information requires two processes in nursing: a verbal summary of the patients' care and another report within the nursing notes, creating duplication. Advances in speech recognition technology have provided an opportunity to consider the practicality of one set of information at the nursing end-of-shift. We used content analysis to compare transcripts from 162 digitally recorded handovers and written nursing notes for similar patients within general medical-surgical wards from two metropolitan hospitals in Sydney Australia. Using the Nursing Handover Minimum Dataset analysis framework similar content [n = 2109 (handover) n = 1902 (nursing notes)] was found within the handovers and notes at the end-of-shift (7:00 am and 2:00 pm). Analysis of the overarching categories demonstrated the emphasis within the differing data sources as: patient identification (31%), care planning or interventions (25%), clinical history (13%), and clinical status (13%) for handover, vs. care planning (47%), clinical status (24%), and outcomes or goals of care (12%) for nursing notes. This study has demonstrated that similar patient information is presented at handover and within documentation. Major categories are consistent with international nursing minimum datasets in use. We can use one set of patient information (within some limitations) for two purposes with system design, practice change and education. Experiments are currently being conducted trialling speech recognition within laboratory and clinical settings. One set of patient information, verbally generated at handover delivering electronic documentation within one process, will transform international nursing policy for nursing handover and documentation. © 2013 International Council of Nurses.

  18. Maryland Public Library Services for the Handicapped. A Survey for Handicapped Accessibility to Public Library Facilities.

    Maryland State Dept. of Education, Baltimore. Div. of Library Development and Services.

    Prepared as a part of an ongoing effort to make Maryland public libraries readily accessible to the handicapped, this directory identifies equipment, services, and facilities available to library users who are confined to wheel chairs and others who have difficulty with steps or stairs. Supplied by the administrators of Maryland's 24 public…

  19. Handicap som risikofaktor? Et udviklingspsykopatologisk perspektiv på børn med handicap

    Dammeyer, Jesper Herup; Bøttcher, Louise


    psykopatologi etableres. I artiklen vil vi præsentere en almen model til forståelse af mennesker med handicap og deres udviklingsmuligheder – en handicappsykologisk udviklingsmodel ud fra et dialektisk kultur-historisk perspektiv (Vygotsky, (1924-31) 1993). Ved hjælp af empiriske studier vil vi eksemplificere...

  20. A comparison of sources of nursing stress and job satisfaction among mental handicap and hospice nursing staff.

    Power, K G; Sharp, G R


    This study compares sources of nursing stress and job satisfaction among 181 mental handicap and 24 hospice nurses. It was hypothesized that nursing stress varies as a consequence of nursing specialty. Analysis of variance revealed differing features of nursing stress between the two specialties. Hospice nurses reported stress as primarily associated with death and dying and inadequate preparation to meet the emotional needs of patients and their families, while mental handicap nurses reported stress related to workload, conflict with other nurses and nursing environment. The results suggest that two additional factors that did not differ between specialties require further examination, namely patient behaviour and purposelessness of nursing care. Job satisfaction also differed between specialties with hospice nurses reporting higher satisfaction with supervision, co-workers, and pay, and lower satisfaction with promotion in comparison to mental handicap nurses. Within the mental handicap groups nursing stress correlated with job satisfaction, state-trait anxiety and non-psychotic psychiatric disturbance in predicted directions. Analysis of the above variables with respect to mental handicap nursing grade was also undertaken. Overall results indicate the importance of nursing specialty as a major factor influencing nursing stress.

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

    Elberse, Janneke Elisabeth; Pittens, Carina Anna Cornelia Maria; de Cock Buning, Tjard; Broerse, Jacqueline Elisabeth Willy


    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 development. A four-phase approach was developed to stimulate needs-articulation concerning future medical products for a broad range of patient groups covering 15 disease domains. 119 (expert) patients and 92 non-patient representatives were consulted using interviews and focus groups. In a facilitated way, patients appeared capable and willing to provide input useful for an advisory process. A broad range of medical products was defined serving different purposes. This study showed two dilemmas: first, finding a balance between a predefined focus and being sufficiently broad to enable patients and patient representatives to contribute, and second, finding a balance between relevance for many patients groups and saturation of data for a lower number of patient groups. By taking the context of patients' daily life as starting point patient groups provided new insights. The predefined focus was sometimes perceived as constraining. The GR considered the articulated needs constructive and incorporated patients' input in their advice to the Minister of Health.

  2. Noise-induced hearing impairment and handicap


    A permanent, noise-induced hearing loss has doubly harmful effect on speech communications. First, the elevation in the threshold of hearing means that many speech sounds are too weak to be heard, and second, very intense speech sounds may appear to be distorted. The whole question of the impact of noise-induced hearing loss upon the impairments and handicaps experienced by people with such hearing losses was somewhat controversial partly because of the economic aspects of related practical noise control and workmen's compensation.

  3. Le Droit de Votre Enfant a une Education: Un Guide pour les Parents d'Enfants Handicapes de l'Etat de New York (Your Child's Right to an Education: A Guide for Parents of Handicapped Children in New York).

    New York State Education Dept. Albany. Office for the Education of Children with Handicapping Conditions.

    The handbook is a French translation of "Your Child's Right to an Education" published by the New York State Education Department, Office for Education of Children with Handicapping Conditions. The following topics are among those considered: eligibility for special education, program types, alternative placements (such as residential settings),…

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

  5. Effects of day-hospital rehabilitation in stroke patients : A review of randomized clinical trials

    Dekker, R; Drost, EAM; Groothoff, JW; Arendzen, JH; van Gijn, JC; Eisma, WH


    The purpose of this study was to review the literature on the effects of day-hospital rehabilitation (DHR) in stroke patients. In The Netherlands DHR concerns a multidisciplinary approach to decrease disability and handicap and to optimize quality of life in an outpatient setting. Data were collecte

  6. Ethical Issues in Withholding Care from Severely Handicapped Infants.

    Cohen, Libby


    Ethical issues are examined that involve withholding medical treatment from severely handicapped infants. Although current laws do not sanction euthanasia, severely handicapped infants are often assisted in dying. Discussion includes society's apparent acceptance of this practice and several solutions to the problems. (Author)

  7. "Euthanasia" of Persons with Severe Handicaps: Refuting the Rationalizations.

    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)

  8. Vocational Reintegration of Handicapped Workers with Assistive Devices

    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…

  9. Learning Experiences for Mentally Handicapped Students in a School Store.

    David, Carol

    A supermarket chain supplies a small grocery store in an elementary school in Jefferson County, Kentucky. The store program seeks to provide learning experiences for students, as they make selections, spend their earnings, and save for later purchases. Students with multiple handicaps and students with severe/profound handicaps shop in the store…

  10. A Career Counseling Model for the Mentally Handicapped.

    Solly, David C.


    A model for career counseling for the mentally handicapped is proposed that addresses goals, method, process, interview techniques, assessment, occupational information, and materials. The process is highly structured and directive, provides predictive and prescriptive information and involves the mentally handicapped individual's parents.…

  11. Handicapped Children and Day Care. Revised and Updated Second Edition.

    Sauer, Ruth Barngrove

    This handbook offers guidance to parents and staff in developing day care programs which include handicapped children. In Section 1 of the handbook, terms commonly used to describe disabilities are defined. Section 2 presents a picture of the current situation in New York City regarding attitudes toward handicapped children and options for their…

  12. Singing voice handicap mapped by different self-assessment instruments.

    Paoliello, Karla; Oliveira, Gisele; Behlau, Mara


    To map voice handicap of popular singers with a general voice and two singing voice self-assessment questionnaires. Fifty singers, 25 male and 25 female, 23 with vocal complaint and 27 without vocal complaint answered randomly the questionnaires. For the comparison of data, the following statistical tests were performed: Mann-Whitney, Friedman, Wilcoxon, Spearman and Correlation. Data showed that the VHI yielded a smaller handicap when compared to the other two questionnaires (VHI x S-VHI - p=0.001; VHI x MSVH - p=0.004). The S-VHI and MSVH produced similar results (p=0.723). Singers with vocal complaint had a VHI total score of 17.5. The other two instruments showed more deviated scores (S-VHI - 24.9; MSVH - 25.2). There was no relationship between gender and singing style with the handicap perceived. A weak negative correlation between the perceived handicap and the time of singing experience was found (-37.7 to -13.10%), that is, the smaller the time of singing experience, the greater the handicap is. The questionnaires developed for the assessment of singing voice, S-VHI and MSVH, showed to be more specific and correspondent to each other for the evaluation of vocal handicap in singers. Findings showed that the more the time of singer's singing experience, the smaller the handicap is. Gender and singing styles did not influence the perception of the handicap.

  13. Epidemiological Study of Mental Health Problems among Handicapped School Children.

    Bahadur Singh, Tej


    Indian teachers rating the prevalence of psychiatric problems in 79 school children with visual handicaps, 91 with hearing handicaps, and 105 nonhandicapped identified a higher prevalence than did psychiatrists. Although similar percentages of children in the 3 groups were diagnosed as having psychiatric problems, the types of problems experienced…

  14. Toy Libraries for the Handicapped: An International Survey.

    Juul, Kristen D.

    A brief history of the toy library movement is offered. Programs for both handicapped and nonhandicapped children in 15 countries are described and the effectiveness of such programs is considered. Two types of toy library programs are defined--the Scandinavian model, or lekotek (designed exclusively for handicapped children and their families and…

  15. "Euthanasia" of Persons with Severe Handicaps: Refuting the Rationalizations.

    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)

  16. Applications of Environmental Psychology in Programming for Severely Handicapped Persons.

    Baker, Dixie Branner


    Theory and research from the field of environmental psychology are reviewed and implications regarding environmental programing for severely handicapped individuals are discussed. A challenge is issued to design for severely handicapped persons environments which are both manageable and consistent with normalization tenets. (Author)

  17. Hepatitis C virus infection in the family setting of patients with occult hepatitis C.

    Castillo, Inmaculada; Bartolomé, Javier; Quiroga, Juan Antonio; Barril, Guillermina; Carreño, Vicente


    Family members of patients with chronic hepatitis C virus (HCV) infection are at increased risk of HCV infection but the prevalence of HCV among family members of patients with occult HCV infection is not known. Anti-HCV, serum HCV RNA and levels of liver enzymes were determined in 102 family members of 50 index patients with occult HCV infection and in 118 family members of 59 chronic hepatitis C index patients. HCV RNA and/or anti-HCV were detected in 10/102 (9.8%) relatives of patients with occult HCV infection and in 4/118 (3.4%) of patients with chronic hepatitis C. Fourteen additional family members (seven were relatives of index patients with occult HCV infection) had abnormal values of liver enzymes without serological markers of HCV infection. Two of these patients (who were relatives of two index patients with occult HCV infection) underwent a liver biopsy and were diagnosed with an occult HCV infection because HCV RNA was detected in the liver cells in the absence of serological HCV markers. In conclusion, the prevalence of HCV infection among family members of patients with occult HCV infection was similar to that found among family members of patients with chronic hepatitis C. This stresses the need to adopt strategies to prevent the transmission of HCV in the family setting of patients with occult HCV infection.

  18. A Qualitative Study of Patients' Attitudes toward HIV Testing in the Dental Setting

    Nancy VanDevanter; Joan Combellick; M. Katherine Hutchinson; Joan Phelan; Daniel Malamud; Donna Shelley


    An estimated 1.1 million people in the USA are living with HIV/AIDS. Nearly 200,000 of these individuals do not know that they are infected. In 2006, the CDC recommended that all healthcare providers routinely offer HIV screening to adolescent and adult patients. Nurse-dentist collaborations present unique opportunities to provide rapid oral HIV screening to patients in dental clinic settings and reach the many adults who lack primary medical providers. However, little is known about the ...

  19. Learning Patient Safety in Academic Settings: A Comparative Study of Finnish and British Nursing Students' Perceptions.

    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 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 prepare nurses for practice in the global context. © 2015 Sigma Theta Tau International.

  20. Analysis and performance of various classification criteria sets in a Colombian cohort of patients with spondyloarthritis.

    Bautista-Molano, Wilson; Landewé, Robert B M; Londoño, John; Romero-Sanchez, Consuelo; Valle-Oñate, Rafael; van der Heijde, Désirée


    The objective of this study was to investigate the performance of classification criteria sets (Assessment of SpondyloArthritis international Society (ASAS), European Spondylarthropathy Study Group (ESSG), and Amor) for spondyloarthritis (SpA) in a clinical practice cohort in Colombia and provide insight into how rheumatologists follow the diagnostic path in patients suspected of SpA. Patients with a rheumatologist's diagnosis of SpA were retrospectively classified according to three criteria sets. Classification rate was defined as the proportion of patients fulfilling a particular criterion. Characteristics of patients fulfilling and not fulfilling each criterion were compared. The ASAS criteria classified 81 % of all patients (n = 581) as having either axial SpA (44 %) or peripheral SpA (37 %), whereas a lower proportion met ESSG criteria (74 %) and Amor criteria (53 %). There was a high degree of overlap among the different criteria, and 42 % of the patients met all three criteria. Patients fulfilling all three criteria sets were older (36 vs. 30 years), had more SpA features (3 vs. 1 features), and more frequently had a current or past history of back pain (77 vs. 43 %), inflammatory back pain (47 vs. 13 %), enthesitis (67 vs. 26 %), and buttock pain (37 vs. 13 %) vs. those not fulfilling any criteria. HLA-B27, radiographs, and MRI-SI were performed in 77, 59, and 24 % of the patients, respectively. The ASAS criteria classified more patients as having SpA in this Colombian cohort when the rheumatologist's diagnosis is used as an external standard. Although physicians do not perform HLA-B27 or imaging in all patients, they do require these tests if the clinical symptoms fall short of confirming SpA and suspicion remains.

  1. Patient Expectations and Perceptions of Goal-setting Strategies for Disease Management in Rheumatoid Arthritis.

    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.

  2. Associated handicaps in children with hearing loss.

    Voutilainen, R; Jauhiainen, T; Linkola, H


    In the differential diagnosis as well as in the rehabilitation of hearing impaired children other disorders affecting language aquisition and speech development need to be taken into account. The rehabilitation programme is highly dependent on the early diagnosis of these additional disorders such as dysphasia, mental retardation of various degrees, cognitive disorders such as dyslexia and dysgraphia, dyspractic and dysarthric disorders of speech production, cleft palate and other anomalies of articulatory organs, autism and other abnormal features of psychic and personality development. In addition children with multiple disorders like malformations, visual disorders, epilepsy, CP and other diseases and handicaps, even though they may not influence language and speech development directly, may still be deprived of possibilities to aquire adequate verbal stimulation. The paper presents a material of 200 children whose hearing loss was diagnosed at the preschool age. Major associated handicaps were found in 35.5% of cases and in 26% they were complicating rehabilitation and development of the child. The frequency of associated disorders and their effect on language and speech development, learning ability and social development is being more closely analysed and discussed.

  3. A comparison of the quality of life of patients with schizophrenia in daycare and homecare settings.

    Kao, Chia-Chan; Huang, Hui-Man


    Deinstitutionalization has been a social movement in Taiwan since 1984. This practice emphasizes quality of life as an important outcome in the treatment of patients with chronic mental illness. This study compares the quality of life of patients with schizophrenia between daycare and homecare settings in Taiwan. A cross-sectional comparison design was used. A convenience sample of 70 participants was drawn from daycare (n = 45) and homecare (n = 25) settings. Three structured questionnaires, a personal characteristics questionnaire, the Quality of Life Scale for Psychiatric Patients, and the Positive and Negative Syndromes Scale, were used to collect personal characteristics, quality of life, and psychopathological status information on participants. Compared with homecare participants, daycare participants had higher quality of life in several domains, more work opportunities, and less severe positive symptoms. Providing work opportunities and proper psychopathology care to patients with schizophrenia may further enhance their quality of life. Practitioners should encourage people with chronic schizophrenia to receive regular care in either a daycare setting or a homecare setting.

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

    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...

  5. Defining a standard set of patient-centered outcomes for men with localized prostate cancer

    N.E. Martin (Neil E.); L. Massey (Laura); C. Stowell (Caleb); C.H. Bangma (Chris); A. Briganti (Alberto); A. Bill-Axelson (Anna); M. Blute (Michael); J.W.F. Catto (James); R.C. Chen (Ronald C.); A.V. D'Amico (Anthony V.); G. Feick (Günter); J.M. Fitzpatrick (John); S.J. Frank (Steven J.); M. Froehner (Michael); M. Frydenberg (Mark); A. Glaser (Adam); M. Graefen (Markus); D. Hamstra (Daniel); A. Kibel (Adam); N. Mendenhall (Nancy); K. Moretti (Kim); J. Ramon (Jacob); I. Roos (Ian); H. Sandler (Howard); F.J. Sullivan (Francis J.); D. Swanson (David); A. Tewari (Ashutosh); A.J. Vickers (Andrew); T. Wiegel (Thomas); H. Huland (Hartwig)


    textabstractBackground Value-based health care has been proposed as a unifying force to drive improved outcomes and cost containment. Objective To develop a standard set of multidimensional patient-centered health outcomes for tracking, comparing, and improving localized prostate cancer (PCa)

  6. Systematic review of approaches to using patient experience data for quality improvement in healthcare settings

    Gleeson, Helen; Calderon, Ana; Swami, Viren; Deighton, Jessica; Wolpert, Miranda; Edbrooke-Childs, Julian


    Objectives Explore how patient-reported experience measures (PREMs) are collected, communicated and used to inform quality improvement (QI) across healthcare settings. Design Systematic review. Setting Various primary and secondary care settings, including general practice, and acute and chronic care hospitals. Participants A full range of patient populations from (children through to the elderly) and staff (from healthcare practitioners to senior managers). Methods Scientific databases were searched (CINAHL, PsycINFO, MEDLINE and Cochrane Libraries) as was grey literature. Qualitative and quantitative studies describing collection of PREM data and subsequent QI actions in any healthcare setting were included. Risk of bias was assessed using established criteria. Of 5312 initial hits, 32 full texts were screened, and 11 were included. Results Patient experience data were most commonly collected through surveys and used to identify small areas of incremental change to services that do not require a change to clinician behaviour (eg, changes to admission processes and producing educational materials). While staff in most studies reported having made effective improvements, authors struggled to identify what those changes were or the impact they had. Conclusions Findings suggest there is no single best way to collect or use PREM data for QI, but they do suggest some key points to consider when planning such an approach. For instance, formal training is recommended, as a lack of expertise in QI and confidence in interpreting patient experience data effectively may continue to be a barrier to a successful shift towards a more patient-centred healthcare service. In the context of QI, more attention is required on how patient experience data will be used to inform changes to practice and, in turn, measure any impact these changes may have on patient experience. PMID:27531733

  7. Counseling Special Students: An Activity Book for Encouraging Positive Interaction Between Non-Handicapped and Handicapped Students.

    Loucks, Hazel

    The activity book is designed to assist school counselors in preparing nonhandicapped persons to interact in a positive manner with the handicapped. An introductory section defines the term handicapped, offers program management guidelines, considers needs assessment, and describes three counseling models (peer helper, classroom guidance, and…

  8. Teaching Basic Discriminations to Handicapped and Non-Handicapped Individuals through a Dynamic Presentation of Intructional Stimuli.

    Gersten, Russel M.; And Others


    Four studies compared static versus dynamic presentations of examples and nonexaples of the concepts "diagonal" and "conves," with nonhandicapped preschoolers, mildly handicapped primary students, and severely handicapped adults. Ss taught with a dynamic presentation learned the discrimination in significantly fewer trials, with performance either…

  9. Transaortic Fallot repair in a grown-up patient: advantages in a situs inversus setting.

    Gil-Jaurena, Juan-Miguel; Cano, Joaquín; Cuenca, Victorio


    We present the case studies of two adult patients with tetralogy of Fallot who were scheduled for surgery. After addressing the right ventricular outflow tract obstruction, the aorta was opened and the ventricular septal defect was approached in a straightforward manner as it was located just under the overriding aortic valve. The second patient presented with was a situs inversus, dextroapex Fallot. In this setting, the aortic approach simplified the repair expeditiously. After 2 years, both patients are in New York Heart Association class I, with no residual ventricular septal defect, no aortic regurgitation, and complete relief of right ventricular outflow tract obstruction.

  10. Intelligent virtual reality in the setting of fuzzy sets

    Dockery, John; Littman, David


    The authors have previously introduced the concept of virtual reality worlds governed by artificial intelligence. Creation of an intelligent virtual reality was further proposed as a universal interface for the handicapped. This paper extends consideration of intelligent virtual realty to a context in which fuzzy set principles are explored as a major tool for implementing theory in the domain of applications to the disabled.

  11. The Emergency Care of Patients With Cancer: Setting the Research Agenda.

    Brown, Jeremy; Grudzen, Corita; Kyriacou, Demetrios N; Obermeyer, Ziad; Quest, Tammie; Rivera, Donna; Stone, Susan; Wright, Jason; Shelburne, Nonniekaye


    To identify research priorities and appropriate resources and to establish the infrastructure required to address the emergency care of patients with cancer, the National Institutes of Health's National Cancer Institute and the Office of Emergency Care Research sponsored a one-day workshop, "Cancer and Emergency Medicine: Setting the Research Agenda," in March 2015 in Bethesda, MD. Participants included leading researchers and clinicians in the fields of oncology, emergency medicine, and palliative care, and representatives from the National Institutes of Health. Attendees were charged with identifying research opportunities and priorities to advance the understanding of the emergency care of cancer patients. Recommendations were made in 4 areas: the collection of epidemiologic data, care of the patient with febrile neutropenia, acute events such as dyspnea, and palliative care in the emergency department setting.

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

    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...... 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....../media (word processing engines, web, mobile apps, and information kiosks). To lower the adoption bar of the system, an MS Word user interface was integrated with the web service layer, and information can now quickly be categorised and grouped according to purpose of use, users can quickly setup information...

  13. Predictors of home death among palliative cancer patients in a primary care setting

    Neergaard, Mette Asbjørn; Olesen, Frede; Vedsted, Peter;

      Background: In most western countries, the majority of palliative cancer patients wish to die at home, where GPs are often deeply involved. However, most research focuses on specialised palliative care, which results in a lack of reliable predictors of home death in primary care. Aim: To analyse...... predictors of home death among deceased palliative cancer patients in a primary care setting. Methods: Using Danish registers, we identified 787 deceased cancer patients and sent a questionnaire to their GPs. The questions concerned the GPs' involvement and the duration of the palliative period at home. We......-of-hours, and whether the GP had had contact with the relatives. Results: 350 questionnaires were filled out. In the preliminary analysis we found that even though many patients died in hospital, this group spent nearly as much of their last time at home as the patients who actually died at home. The analysis...

  14. Communicating with culturally and linguistically diverse patients in an acute care setting: nurses' experiences.

    Cioffi, R N Jane


    Communication with culturally and linguistically diverse (CLD) patients has been shown to be difficult. This study describes nurses' experiences of communicating with CLD patients in an acute care setting. A purposive sample of registered nurses and certified midwives (n=23) were interviewed. Main findings were: interpreters, bilingual health workers and combinations of different strategies were used to communicate with CLD patients; some nurses showed empathy, respect and a willingness to make an effort in the communication process with others showing an ethnocentric orientation. Main recommendations were: prioritising access to appropriate linguistic services, providing nurses with support from health care workers, e.g., bilingual health care workers who are able to provide more in-depth information, increasing nurses' understanding of legal issues within patient encounters, supporting nurses to translate their awareness of cultural diversity into acceptance of, appreciation for and commitment to CLD patients and their families.

  15. Clinical characteristics of patients with lymphoproliferative neoplasms in the setting of systemic autoimmune diseases.

    Suvajdzic, Nada; Djurdjevic, Predrag; Todorovic, Milena; Perunicic, Maja; Stojanović, Roksanda; Novkovic, Aleksandra; Mihaljevic, Biljana


    Clinical features of 40 lymphoproliferative neoplasm patients in the setting of systemic autoimmune diseases managed in the Clinic of Hematology during 1994-2006 were analyzed retrospectively. The classification of systemic autoimmune disease patients was as follows: 15 systemic lupus erythematosus--SLE, 11 rheumatoid arthritis--RA, 12 Sjögren's syndrome--SS, 1 scleroderma, and 1 dermatomyositis. Patients comprised 31 women and 9 men of mean age 55 years (range 33-76). Systemic autoimmune diseases preceeded the development of lymphoproliferative neoplasms in 37/40 (92.5%) patients. Mean latency period between the onset of systemic autoimmune diseases and lymphoproliferative neoplasms occurrence was significantly longer in RA (113 months) than in SLE (75 months) and SS patients (65 months)--P autoimmune diseases type or antirheumatic treatment P > 0.05. Our findings are in line with earlier reports showing a high proportion of patients with advanced disease, constitutional symptoms, extranodal manifestations, high grade histology, and low OS in the systemic autoimmune diseases setting.

  16. Nutritional management of critically ill trauma patients in the deployed military setting.

    Jansen, J O; Turner, S; Johnston, A McD


    The role of nutritional support in critical illness is well established. This article reviews the nutritional management of military trauma patients in the deployed setting, which poses special challenges for the surgeon and intensivist. There is little direct evidence relating to the nutritional management of trauma patients in general, and military trauma patients in particular, but much of the evidence accrued in the civilian and non-trauma critical care setting can be extrapolated to military practice. There is strong consensus that feeding should be commenced as soon possible after injury. Enteral nutrition should be used in preference to parenteral nutrition whenever possible. If available, supplemental parenteral feeding can be considered if enteral delivery is insufficient. Gastrointestinal anastomoses and repairs, including those in the upper gastrointestinal tract, are not a contraindication to early enteral feeding. Intragastric delivery is more physiological and usually more convenient than postpyloric feeding, and thus the preferred route for the initiation of nutritional support. Feeding gastrostomies or jejunostomies should not be used for short-term nutritional support. Enteral feeding of patients with an open abdomen does not delay closure and may reduce the incidence of pneumonia, and enteral nutrition should be continued for scheduled relook surgery not involving hollow viscera or airway. Glutamine supplementation may improve outcome in trauma patients, but fish-oil containing feeds, while showing some promise, should be reserved for subgroups of patients with ARDS.

  17. 38 CFR 18.434 - Education setting.


    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Education setting. 18.434... Adult Education § 18.434 Education setting. (a) Academic setting. A recipient shall educate, or shall provide for the education of, each qualified handicapped person in its jurisdiction with persons who are...

  18. Indian patients' attitudes towards chairside screening in a dental setting for medical conditions.

    Sansare, Kaustubh; Raghav, Mamta; Kasbe, Abhiram; Karjodkar, Freny; Sharma, Neeraj; Gupta, Ambika; Singh, Harneet; Iyengar, Asha; Patil, Seema; Selvamuthukumar, Sanarpalayam C; Krithika, Chandrasekaran; Glick, Michael; Greenberg, Barbara L


    India has a high prevalence of cardiovascular disease (CVD), diabetes mellitus (DM), tuberculosis (TB), human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) and hepatitis B. United States-based studies indicate provider and patient support for medical screening in the dental setting. We assessed patient attitudes towards, and willingness to participate in, medical screening in the dental setting in India. A 5-point Likert scale survey (with scores ranging from 1=very important/willing to 5=very unimportant/unwilling) was given to a convenience sample of adult patients visiting five university-based dental clinics (clinic group) and one private-practice setting (private group). The Mann-Whitney U-test was used to compare mean response scores between patient groups. Logistic regression was used to assess factors associated with a favourable outcome. Both patient groups felt it important for dentists to identify increased risk for medical conditions (89.3% vs. 94.9%, respectively; P=0.02). The majority of patients were willing to have a dentist screen for the specified conditions: CVD (80.6% clinic and 84.5% private); DM (84.5% clinic and 77.5% private); TB (76.7% clinic and 73.2% private); hepatitis (73.3% clinic and 67.5% private); and HIV/AIDS (71.0% clinic and 70.5% private). The majority of patients were willing to participate in chairside screening that yielded immediate results (84.6% clinic and 86.1% private), discuss results immediately (85.8% clinic and 87.2% private) and pay 150 Indian rupees (55.9% clinic and 91.7% private). Younger patients (dental settings [adjusted odds ratio (OR)=0.63; 95% confidence interval (95% CI): 0.26-0.84] and be available for screening that yielded immediate results (adjusted OR=0.63; 95% CI: 0.40-0.99). Indian dental patients were in favour of chairside medical screening. © 2015 FDI World Dental Federation.

  19. Stereotypes concerning normal and handicapped children.

    Parish, T S; Dyck, N; Kappes, B M


    Individuals' attitudes were assessed toward various groups of children. In study 1 the respondents were 65 male and female teachers from across the state of Kansas. In study 2 the respondents were 89 men and women in attendance at the 1978 International Conference of the Association for Children with Learning Disabilities. In both studies the evaluations of the labels "gifted children," "normal children," and "physically handicapped children" were found to be significantly more positive than the evaluations of the labels "mentally retarded children," "learning disabled children," and "emotionally disturbed children." These results seem to indicate that definite negative stereotypes are held toward the latter three groups of children. In study 1 these findings were found to occur generally regardless of the respondents' sex, age, educational level attained, and amount of previous mainstreaming experience.

  20. Analysis of Triwheeler for Handicapped Person

    Onkar Wadkar


    Full Text Available Solar plays a vital role in day to day life. In this project we have discussed that how solar tri-wheeler will help to reduce the eff ort of handicapped person. All the designs specification considered after analyzing the problems from the handicapped person. Comfort of the person in the tri-wheeler is an important and we have given importance to it. The main content of the tri-wheeler is Solar PV panel, Brushless PMDC motor, Charge controller and battery. In this project we have discuss about the main idea of this project and to get a larger picture on what is the problem in the current technologies, what that we want to achieve in this project and the area that will cover on this project. This project is divided into some categories that are project background to describe the reasons to do this project, problem statement to inform about the problem or weakness of the existing technology, objective to make sure what actually this project must achieve and scope of this project to specify what will be used in this project. In automobile sector, the need for alternative fuel as a replacement of conventional fossil fuel, due to its depletion and amount of emission has given way for new technologies like Electric vehicles. Still a lot of advancement has to take place in these technologies for commercialization. The gap between the current fossil fuel technology and zero emission vehicles can be bridged by this technology. The electrical power is used to achieve either better fuel economy than a conventional vehicle, better performance and it cause less pollution. Driving mode selectivity improves this system more economical, stable and more efficient

  1. Rough Set Theory based prognostication of life expectancy for terminally ill patients.

    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.

  2. Medical students developing confidence and patient centredness in diverse clinical settings: a longitudinal survey study.

    McNair, Ruth; Griffiths, Leonie; Reid, Katharine; Sloan, Hannah


    Medical student clinical confidence and positive attitudes to patient centredness are important outcomes of medical education. The clinical placement setting is regarded as a critical support to these outcomes, so understanding how the setting is influential is important. The aim of this study was to compare students' attitudes towards patient-centredness and clinical confidence as they progressed through their medical course, and understand the influence of diverse clinical placement zones. Students at one Australian medical school completed a questionnaire at the beginning of second year and at the end of their third year of medical training. The questionnaire measured attitudes to patient centred care, clinical confidence, role modelling experiences and clinical learning experiences. Descriptive analyses investigated change in these attitudes over time. Repeated measures analysis of variance was used to assess the influence of placement location on each variable of interest. Responses to two open-ended questions were also coded by two researchers and themes were identified. Student confidence increased over the course of two years of clinical training (p Students had positive attitudes towards patient-centredness throughout, and noted its importance in contributing to quality care. Patient-centred care was encouraged within the clinical placements, and was influenced by positive and negative role modelling, direct teaching, and opportunities to practise patient-centred care. A new generation of doctors with a strong patient-centred focus is emerging. Medical schools have a responsibility to facilitate clinical placements that will support the acquisition and maintenance of skills in patient centred care through positive role modelling.

  3. Correlation between Voice Handicap Index(VHI)and Voice Acoustic Analysis in Patients with Vocal Cord Polyps%声带息肉患者的嗓音声学分析与VHI的相关性研究

    高洁; 屈季宁


    目的 探讨嗓音声学分析与嗓音障碍指数(voice handicap index,VHI)用于嗓音质量评估的临床意义及其相关性,并进一步验证VHl的实用性.方法 对35名声带息肉患者(患者组)及35名嗓音正常人(对照组)进行嗓音声学分析和VHI调查,嗓音声学分析指标包括振幅扰动商(amptitude perturbation quotient,APQ)、基频微扰(jitter)、振幅微扰(shimmer)、噪/谐比(NHR),VHI调查包括功能(F)、生理(P)、情感(E)三个范畴,记录三方面得分及总分(TVH)分值.结果患者组的APQ、jitter、shimmer、NHR均高于正常组,差异有统计学意义(P<0.05);患者组VHI的TVH平均值为43.32±4.66分,而正常组的平均值为12.51±1.88分,两组间差异有统计学意义(P<0.05).声带息肉患者嗓音声学分析参数与VHI之间无显著相关性.结论 临床上不能以嗓音声学分析为标准来判断或推测声带息肉患者症状轻重;VHI可主观反映患者嗓音障碍程度.

  4. Improper sharp disposal practices among diabetes patients in home care settings: Need for concern?

    Anindo Majumdar; Jayaprakash Sahoo; Gautam Roy; Sadishkumar Kamalanathan


    In the recent years, outbreaks of blood-borne infections have been reported from assisted living facilities, which were traced back to improper blood glucose monitoring practices. Needle-stick injuries have been implicated in many such cases. This directly raises concerns over sharp disposal practices of diabetic patients self-managing their condition in home care settings. With India being home to a huge diabetic population, this issue, if neglected, can cause substantial damage to the healt...

  5. Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals

    Thompson, E. A.; Mathie, R. T.; Baitson, E.S.; Barron, S J; Berkovitz, S.R.; Brands, M.; Fisher, P.; Kirby, T.M.; Leckridge, R.W.; Mercer, S.W.; Nielsen, H J; Ratsey, D.H.K.; Reilly, D.; Roniger, H.; Whitmarsh, T.E.


    We report findings from a pilot data collection study within a programme of quality assurance, improvement and development across all five homeopathic hospitals in the UK National Health Service (NHS).\\ud \\ud Aims (1) To pilot the collection of clinical data in the homeopathic hospital outpatient setting, recording patient-reported outcome since first appointment; (2) to sample the range of medical complaints that secondary-care doctors treat using homeopathy, and thus identify the nature and...

  6. The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol.

    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

  7. Exploratory factor analysis of the Dizziness Handicap Inventory (German version

    de Bruin Eling D


    Full Text Available Abstract Background The Dizziness Handicap Inventory (DHI is a validated, self-report questionnaire which is widely used as an outcome measure. Previous studies supported the multidimensionality of the DHI, but not the original subscale structure. The objectives of this survey were to explore the dimensions of the Dizziness Handicap Inventory - German version, and to investigate the associations of the retained factors with items assessing functional disability and the Hospital Anxiety and Depression Scale (HADS. Secondly we aimed to explore the retained factors according to the International Classification of Functioning, Disability and Health (ICF. Methods Patients were recruited from a tertiary centre for vertigo, dizziness or balance disorders. They filled in two questionnaires: (1 The DHI assesses precipitating physical factors associated with dizziness/unsteadiness and functional/emotional consequences of symptoms. (2 The HADS assesses non-somatic symptoms of anxiety and depression. In addition, patients answered the third question of the University of California Los Angeles-Dizziness Questionnaire which covers the impact of dizziness and unsteadiness on everyday activities. Principal component analysis (PCA was performed to explore the dimensions of the DHI. Associations were estimated by Spearman correlation coefficients. Results One hundred ninety-four patients with dizziness or unsteadiness associated with a vestibular disorder, mean age (standard deviation of 50.6 (13.6 years, participated. Based on eigenvalues greater one respectively the scree plot we analysed diverse factor solutions. The 3-factor solution seems to be reliable, clinically relevant and can partly be explained with the ICF. It explains 49.2% of the variance. Factor 1 comprises the effect of dizziness and unsteadiness on emotion and participation, factor 2 informs about specific activities or effort provoking dizziness and unsteadiness, and factor 3 focuses on self

  8. Prediction and set-dependent scaling of early postural responses in cerebellar patients.

    Timmann, D; Horak, F B


    We reported previously that patients with cerebellar deficits were unable to scale the magnitude of their early automatic postural responses to the predicted amplitudes of surface translations based on central set from prior experience. The present study investigated whether this deficit in set-dependent amplitude scaling was based predominantly on the cerebellar patient's disability (i) to predict perturbation amplitudes on the basis of prior experience, (ii) to scale the gain or magnitude of upcoming postural responses or (iii) to habituate postural responses. The increase in size of the early postural response when a larger than actual platform amplitude was expected and decrease when a smaller one was expected was defined as a measure of set-dependent amplitude prediction. The suppression of the postural response when the same platform velocity was repeated was used as a measure of habituation. The correlation between the size of early postural responses and platform amplitudes when presented serially, but not randomly, tested the ability to scale the gain of postural responses based on prior experience. Results show that although cerebellar patients could predict perturbation amplitudes based on prior experience, they could not use this prediction to modify precisely the gain of responses. The ability to habituate the magnitude of postural responses was not affected by cerebellar lesions. Thus, the cerebellum might not be critical for predicting upcoming events or for habituating to repeated postural stimuli, although it is important for accurate tuning of response gain based on prediction.

  9. A Prospective Survey of Patient Drop-outs in a Palliative Care Setting.

    Unni, Kumudam; Edasseri, Divakaran


    A prospective survey of patient drop-outs was carried out in a palliative care setting to understand the background of patients in the drop-out category. This was to understand the background of patients who drop out and why they drop out. The survey was conducted on 425 patients who had registered in the clinic in 2009 and subsequently persistently dropped out. Patients were classified on the basis of age, gender, education, disease, socioeconomic class, distance from clinic to home, family size, general health on the basis of symptoms on first arrival, reasons subsequently found for missing the appointment, primary caregiver details, and social support. The data were collected, and analyzed statistically using chi-square tests and percentages. Majority of patients presented in the 41- to 60-year age group had secondary level education, with a family size of four. The drop-out rate was 25.06%. There was a significant association (P = 0.026) between reasons for dropping out and social support. A P-value drop-out rate decreases. Majority of patients discontinued because a similar facility became available nearer their residence. A number of palliative care clinics have been created in the district and this has resulted in the significant drop-out rate.

  10. Achievement of national cholesterol education program goals by patients with dyslipidemia in rural ambulatory care settings.

    Qayyum, Rehan; Chattha, Ashraf A; Bhullar, Navneet; Katsetos, Manny; Schulman, Peter


    The Third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program provides guidelines for managing dyslipidemia; however, studies from large centers find that most dyslipidemic patients fail to achieve management goals. Few data exist on lipid management in rural settings. To determine the proportion of rural dyslipidemic patients achieving ATP III goals, records of 461 patients were reviewed from 4 practices. Only 54% of the patients with dyslipidemia achieved ATP III goals. Patients with diabetes or with a family history of premature coronary heart disease were less likely to achieve ATP III goals (odds ratio 0.56; 95% confidence interval, 0.38-0.84 and odds ratio 0.42; 95% confidence interval, 0.25-0.71, respectively). Patients taking statins were more likely to achieve goals (odds ratio 3.23; 95% confidence interval, 2.13-4.89). These results indicate that a significant proportion of patients with dyslipidemia in rural practices do not achieve management goals. Strategies to improve lipid management in rural practices are needed.

  11. Registration of electronic portal images for patient set-up verification.

    Matsopoulos, George K; Asvestas, Pantelis A; Delibasis, Konstantinos K; Kouloulias, Vassilios; Uzunoglu, Nikolaos; Karaiskos, Pantelis; Sandilos, Panagiotis


    Images acquired from an electronic portal imaging device are aligned with digitally reconstructed radiographs (DRRs) or other portal images to verify patient positioning during radiation therapy. Most of the currently available computer aided registration methods are based on the manual placement of corresponding landmarks. The purpose of the paper is twofold: (a) the establishment of a methodology for patient set-up verification during radiotherapy based on the registration of electronic portal images, and (b) the evaluation of the proposed methodology in a clinical environment. The estimation of set-up errors, using the proposed methodology, can be accomplished by matching the portal image of the current fraction of the treatment with the portal image of the baseline treatment (reference portal image) using a nearly automated technique. The proposed registration method is tested on a number of phantom data as well as on data from four patients. The phantom data included portal images that corresponded to various positions of the phantom on the treatment couch. For each patient, a set of 30 portal images was used. For the phantom data (for both transverse and lateral portal images), the maximum absolute deviations of the translational shifts were within 1.5 mm, whereas the in-plane rotation angle error was less than 0.5 degrees. The two-way Anova revealed no statistical significant variability both within observer and between-observer measurements (P > 0.05). For the patient data, the mean values obtained with manual and the proposed registration methods were within 0.5 mm. In conclusion, the proposed registration method has been incorporated within a system, called ESTERR-PRO. Its image registration capability achieves high accuracy and both intra- and inter-user reproducibility. The system is fully operational within the Radiotherapy Department of 'HYGEIA' Hospital in Athens and it could be easily installed in any other clinical environment since it requires

  12. Doctor-patient communication without family is most frequently practiced in patients with malignant tumors in home medical care settings.

    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.

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

    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.

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

    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

  15. Developing Spatial-Movement Concepts in Multiply Handicapped Students.

    Liberti, Gina


    The article describes a group motor-route activity to help mulitply handicapped blind students develop a complete understanding of spatial-movement concepts and to increase their cognitive motor skills. (Author/CL)

  16. Use of Teacher Nonverbal Cues with Handicapped Students.

    Hillison, John; Crunkilton, John R.


    Teachers can use nonverbal forms of communication (facial expression, gestures, space, eye contact, body orientation, tone of voice, and head nod/head shake) to enhance the communication process with their handicapped students. (CL)

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

    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

  18. Horticulture for Secondary Level Handicapped Adolescents: The Cherokee County Model.

    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)

  19. Epilepsy: Impact upon Severely and Profoundly Handicapped Persons.

    Spooner, Fred; Dykes, Mary K.


    The paper synthesizes information about epilepsy (definition and categories of seizures, types of seizures, and treatment) and notes its impact upon persons with severe/profound handicaps. The need for a transdisciplinary team in case management is cited. (CL)

  20. Assessing the relationship between patient satisfaction and clinical quality in an ambulatory setting.

    Bosko, Tawnya; Wilson, Kathryn


    Purpose The purpose of this paper is to assess the relationship between patient satisfaction and a variety of clinical quality measures in an ambulatory setting to determine if there is significant overlap between patient satisfaction and clinical quality or if they are separate domains of overall physician quality. Assessing this relationship will help to determine whether there is congruence between different types of clinical quality performance and patient satisfaction and therefore provide insight to appropriate financial structures for physicians. Design/methodology/approach Ordered probit regression analysis is conducted with overall rating of physician from patient satisfaction responses to the Clinician and Groups Consumer Assessment of Healthcare Providers and Systems survey as the dependent variable. Physician clinical quality is measured across five composite groups based on 26 Healthcare Effectiveness Data and Information Set (HEDIS) measures aggregated from patient electronic health records. Physician and patient demographic variables are also included in the model. Findings Better physician performance on HEDIS measures are correlated with increases in patient satisfaction for three composite measures: antibiotics, generics, and vaccination; it has no relationship for chronic conditions and is correlated with decrease in patient satisfaction for preventative measures, although the negative relationship for preventative measures is not robust in sensitivity analysis. In addition, younger physicians and male physicians have higher satisfaction scores even with the HEDIS quality measures in the regression. Research limitations/implications There are four primary limitations to this study. First, the data for the study come from a single hospital provider organization. Second, the survey response rate for the satisfaction measure is low. Third, the physician clinical quality measure is the percent of the physician's relevant patient population that met

  1. Patient Communication in Health Care Settings: new Opportunities for Augmentative and Alternative Communication.

    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.

  2. Progressively engaging: constructing nurse, patient, and family relationships in acute care settings.

    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.

  3. Real-world impact of education: treating patients with ipilimumab in a community practice setting.

    Ledezma, Blanca; Heng, Annie


    After decades without promising new treatments for advanced and metastatic melanoma, ipilimumab was the first systemic therapy approved for use in this patient population. A fully human monoclonal antibody that blocks cytotoxic T-lymphocyte antigen 4 (CTLA-4) to augment antitumor T-cell responses, ipilimumab significantly extended overall survival in clinical trials. Because ipilimumab is associated with a set of immune-related adverse events that likely reflect the agent's mechanism of action, a management guide has been established. Nurses play a significant role in initially identifying these adverse reactions and assisting in patient education, treatment, and follow-up. Herein, we discuss commonly asked questions related to ipilimumab therapy and treatment of adverse events, and how nurses can be prepared to answer these questions as they arise from patients and caregivers.

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

    Paulsen, Aksel; Pedersen, Alma B; 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......-6, or 10-11 years previously were randomly selected from the Danish Hip Arthroplasty Register and sent 2 PRO questionnaires: 1 generic (EuroQoL-5D or SF-12 health survey) and 1 disease-specific (hip dysfunction and osteoarthritis outcome score (HOOS) or Oxford 12-item hip score). We compared response rates......, floor and ceiling effects, missing items, and the need for manual validation of forms. Results 4,784 patients (mean age 71 years, 57% females) were included (83%). The response rates ranged from 82-84%. Statistically significantly different floor and ceiling effects ranged from 0% to 0.5% and from 6...

  5. Screening of patients with diabetes mellitus for tuberculosis in community health settings in China.

    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.

  6. Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

    Chin Yee Cheong


    Full Text Available Background/Aims: The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT programme on mood and engagement in older patients with delirium and/or dementia (PtDD in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods: Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4 were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy on 3 consecutive days: day 1 (control condition without music and days 2 and 3 (with CMT. Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES and Observed Emotion Rating Scale (OERS. Results: Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01 in MPES and pleasure and general alertness (Z = 3.188,p = 0.01 in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014. Negative engagement (Z = 2.582, p = 0.01 and affect (Z = 2.004, p = 0.045 were both lower during CMT compared to no music. Conclusion: These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation.

  7. Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

    Cheong, Chin Yee; Tan, Jane An Qi; Foong, Yi-Lin; Koh, Hui Mien; Chen, Denise Zhen Yue; Tan, Jessie Joon Chen; Ng, Chong Jin; Yap, Philip


    Background/Aims The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation. PMID:27489560

  8. Care coordination for patients with complex health profiles in inpatient and outpatient settings.

    Berry, Leonard L; Rock, Beth L; Smith Houskamp, Beth; Brueggeman, Joan; Tucker, Lois


    Patients with the most complex health profiles consume a disproportionate percentage of health care expenditures, yet often receive fragmented, suboptimal care. Since 2003, Wisconsin-based Gundersen Health has improved the quality of life and reduced the cost burden of patients with complex health profiles with an integrated care coordination program. Those results are consistent with data from the most successful care coordination demonstration projects funded by the Centers for Medicare and Medicaid Services. Specifically, Gundersen's program has been associated with reduced hospital stays, lower costs for inpatients, less use of inpatient services, and increased patient satisfaction. Gundersen's success is rooted in its team-based approach to coordinated care. Teams, led by a subspecialty-trained nurse, have regular, face-to-face contact with patients and their physicians in both inpatient and outpatient settings; involve patients deeply in care-related decisions; access a system-wide electronic medical record database that tracks patients' care; and take a macrolevel view of care-related factors and costs. Gundersen's model offers specific take-home lessons for institutions interested in coordinated care as they design programs aimed at improving quality and lowering costs. This institutional case study provides a window into well-executed care coordination at a large health care system in an era when major changes in health care provision and reimbursement mechanisms are on the horizon.

  9. The community deals with the child who has a handicap.

    Bullard, I D; Dohnal, J T


    Exclusion messages, however subtle, are interwoven into the community of the child who is handicapped. The subsystems of family, religion, neighborhood, education, health care, and financial assistance agencies have good intentions but frequently communicate poorly with the child and the parents. What is meant as a help becomes a hindrance for the child who must adapt to a limitation while continuing to move toward self-esteem, self-sufficiency, and skills that will enhance productivity and employability. No one negative message will destroy a handicapped child: it is the "history of learned inferiority" that cripples the child who is handicapped. Only when able-bodied individuals within the subsystems recognize the cumulative effect of these messages will the community be responsive to the real needs of the child who has a handicap. Nurses, schooled in sensitivity for the person, should resolve to be in the vanguard in this movement, becoming ever more sensitive to the needs of the handicapped. Such a giant step will begin a fresh and long-needed approach toward understanding those needs central to the well-being of the child who resides in the community and is also handicapped.

  10. Self-Handicapping and Its Impact on Mental Health

    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

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

    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

  12. [Partnership and role of the psychiatrist beside the mentally handicapped persons and their families].

    Lecuyer, R


    Partnership and role of the psychiatrist beside the mentally handicapped persons and their families. The author analyses his 35 years long collaboration with parents and their associations, and the follow up of mentally handicapped persons themselves. The author questions:--the generalisation of debatable theories without enough explicativity, which makes difficult the "therapeutic alliance" with the parents--the deficiency of educative projects--the doubtful reactions from the responsibles of parents associations in the scientifical spheres, and their refusal to make up their mind with some incomplete results of education. However, the collaboration with most of the parents is usually efficient and pleasant. It seems difficult to manage the psychopedagogy with the toddlers and the polyhandicapped persons without them. Finally, the author insists on the necessity of a patient psychological preparing of the handicapped person, in order he becomes conscience of his difference. Argument for a reflexion about each one role and responsibility, for a real partner-ship, with harmony and complementarity.

  13. Patient question set proliferation: scope and informatics challenges of patient question set management in a large multispecialty practice with case examples pertaining to tobacco use, menopause, and Urology and Orthopedics specialties.

    Vande Loo, Sarah J; North, Frederick


    Health care institutions have patient question sets that can expand over time. For a multispecialty group, each specialty might have multiple question sets. As a result, question set governance can be challenging. Knowledge of the counts, variability and repetition of questions in a multispecialty practice can help institutions understand the challenges of question set proliferation. We analyzed patient-facing question sets that were subject to institutional governance and those that were not. We examined question variability and number of repetitious questions for a simulated episode of care. In addition to examining general patient question sets, we used specific examples of tobacco questions, questions from two specialty areas, and questions to menopausal women. In our analysis, there were approximately 269 institutionally governed patient question sets with a mean of 74 questions per set accounting for an estimated 20,000 governed questions. Sampling from selected specialties revealed that 50 % of patient question sets were not institutionally governed. We found over 650 tobacco-related questions in use, many with only slight variations. A simulated use case for a menopausal woman revealed potentially over 200 repeated questions. A group practice with multiple specialties can have a large volume of patient questions that are not centrally developed, stored or governed. This results in a lack of standardization and coordination. Patients may be given multiple repeated questions throughout the course of their care, and providers lack standardized question sets to help construct valid patient phenotypes. Even with the implementation of a single electronic health record, medical practices may still have a health information management gap in the ability to create, store and share patient-generated health information that is meaningful to both patients and physicians.

  14. Interviewing patients using interpreters in an oncology setting: initial evaluation of a communication skills module.

    Lubrano di Ciccone, B; Brown, R F; Gueguen, J A; Bylund, C L; Kissane, D W


    To develop a communication skills training (CST) module for health care professionals, particularly in the area of oncology, on how to conduct interviews using interpreters and to evaluate the module in terms of participant's self-efficacy and satisfaction. Forty-seven multi-specialty health care providers from the New York Metropolitan Area attended a communication skills module at a Comprehensive Cancer Care Center about how to conduct clinical interviews utilizing interpreters. The development of this module was on the basis of current literature and followed the Comskil model previously utilized for other doctor-patient CSTs. Participants were given pre- and post-surveys to evaluate their own confidence as well as the helpfulness of the module. On the basis of a retrospective pre-post measure, participants reported an increase in their confidence about interviewing patients via translators. In addition, at least 80% of participants reported their satisfaction with the various components of the module by either agreeing or strongly agreeing with the different statements. We have developed a module that trains clinicians in effective collaboration with professional medical interpreters and shown its ability to increase the confidence of clinician's to work with limited English proficiency patients. Our approach intends to minimize not only the language barrier but also the cultural barriers that could potentially interfere with patients' care. This work has important practice implications in the oncology setting, where cultural sensitivity is paramount and empathic exchange with the patient optimizes their sense of being well supported by their health care team. We believe that this model is generalizable to many other medical settings where use needs to be made of a professional interpreter.

  15. Patient counseling in community pharmacy and its relationship with prescription payment methods and practice settings.

    Raisch, D W


    To determine whether patient counseling activities in community pharmacies are related to payment method and practice setting. Randomly selected pharmacists voluntarily performed self-data collection (39 percent participation rate) of counseling activities for 40 hours. Observational data were also collected by trained observers. Community pharmacies. Forty-seven pharmacists in national chain pharmacies and 26 in independent pharmacies collected data on 3766 counseling events. Patient counseling rates, defined as percentage of patients counseled per prescription per pharmacist, were significantly higher (p chain (median 17.7 percent) than for independent pharmacists (10.7 percent). Although there was no difference in terms of pharmacist-initiated counseling, chain pharmacists had higher rates of patient-initiated counseling per prescription (median 4.3 percent) than independent pharmacists (median 2.7 percent) (p Independent pharmacists' higher number of capitation patients and increased workloads may have affected their counseling activities. These findings have implications for pharmacy service reimbursement programs, practice conditions, and continuing education programs.

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

    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.    

  17. Identifying homogenous subgroups for individual patient meta-analysis based on Rough Set Theory.

    Gil-Herrera, Eleazar; Tsalatsanis, Athanasios; Kumar, Ambuj; Mhaskar, Rahul; Miladinovic, Branko; Yalcin, Ali; Djulbegovic, Benjamin


    Failure to detect and manage heterogeneity between clinical trials included in meta-analysis may lead to misinterpretation of summary effect estimates. This may ultimately compromise the validity of the results of the meta-analysis. Typically, when heterogeneity between trials is detected, researchers use sensitivity or subgroup analysis to manage it. However, both methods fail to explain why heterogeneity existed in the first place. Here we propose a novel methodology that relies on Rough Set Theory (RST) to detect, explain, and manage the sources of heterogeneity applicable to meta-analysis performed on individual patient data (IPD). The method exploits the RST relations of discernibility and indiscernibility to create homogeneous groups of patients. We applied our methodology on a dataset of 1,111 patients enrolled in 9 randomized controlled trials studying the effect of two transplantation procedures in the management of hematologic malignancies. Our method was able to create three subgroups of patients with remarkably low statistical heterogeneity values (16.8%, 0% and 0% respectively). The proposed methodology has the potential to automatize and standardize the process of detecting and managing heterogeneity in IPD meta-analysis. Future work involves investigating the applications of the proposed methodology in analyzing treatment effects in patients belonging to different risk groups, which will ultimately assist in personalized healthcare decision making.

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

    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.

  19. Characteristics of Patients with an Abnormal Glasgow Coma Scale in the Prehospital Setting

    Durant, Edward


    Full Text Available Objective: This cross-sectional study describes the characteristics of patients with an abnormal Glasgow Coma Scale (GCS in the prehospital setting.Methods: We reviewed existing prehospital care reports (PCRs in the San Mateo County, California, emergency medical services (EMS database from January 1 to December 31, 2007. Adults age 18 or greater with a documented GCS fit inclusion criteria. We excluded single and multisystem trauma patients, as well as patients in cardiac arrest, respiratory arrest, or listed as deceased from the study. We classified the remaining patients as a normal GCS of 15 or abnormal (defined as less than 15 at any time during paramedic contact, and then further sub-classified into mild (GCS 13-14, moderate (GCS 9-12 or severe (GCS 3-8.Results: Of the 12,235 unique prehospital care record in the database, 9,044 (73.9% met inclusion criteria, comprised of 2,404 (26.6% abnormal GCS patients and 6,640 (73.4% normal GCS patients. In the abnormal GCS category, we classified 1,361 (56.6% patients as mild, 628 (26.1% as moderate, and 415 (17.3% as severe. Where sex was recorded, we identified 1,214 (50.5% abnormal GCS patients and 2,904 (43.7% normal GCS patients as male. Mean age was 65.6 years in the abnormal GCS group and 61.4 in the normal GCS group (p<0.0001. Abnormal GCS patients were more likely to have a history of conditions known to be associated, such as alcohol abuse (odds ratio [OR] 2.3, 95% confidence interval [CI]=2.75-3.00, diabetes (OR 1.34, 95% CI=1.17-1.54, substance abuse (OR 1.6, CI=1.09-2.3, stroke/transient ischemic attack (OR 2.0, CI=1.64-2.5, and seizures (OR 3.0, CI=1.64-2.5. Paramedics established intravenous (IV access on 1,821 (75.7%, OR 1.94, CI=1.74-2.2 abnormal GCS patients and administered medications to 777 (32.3%, OR 1.01, CI=0.92-1.12. Compared to patients with normal GCS, patients with a mildly abnormal GCS were less likely to receive medications (OR 0.61, CI=0.53-0.70 while those with a

  20. Patient perspectives and preferences for communication of medical imaging risks in a cancer care setting.

    Thornton, Raymond H; Dauer, Lawrence T; Shuk, Elyse; Bylund, Carma L; Banerjee, Smita C; Maloney, Erin; Fox, Lindsey B; Beattie, Christopher M; Hricak, Hedvig; Hay, Jennifer


    To identify opportunities for improving patient-centered communication about diagnostic imaging tests that involve the use of radiation in a cancer care setting. Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. Patient knowledge, information sources, and communication preferences were assessed in six focus groups during 2012. The groups consisted of patients undergoing treatment for metastatic colorectal carcinoma, women treated within the past 6 months for early-stage breast carcinoma, men undergoing surveillance after testicular cancer treatment, parents of patients treated for stage I-III neuroblastoma, patients in a thoracic oncology survivorship program, and participants in a lung cancer screening program. A multidisciplinary research team performed thematic content analysis of focus group transcripts. High-level findings were summarized during consensus conferences. Although they were aware of the long-term risk of cancer from exposure to ionizing radiation, most participants reported that their health care provider did not initiate discussion about benefits and risks of radiation from imaging tests. Most patients obtained information by means of self-directed internet searches. Participants expressed gratitude for tests ("That CT saved my daughter's life," "I'd rather have the radiation dosage than being opened up"), yet they expressed concern about having to initiate discussions ("If you don't ask, nobody is going to tell you anything") and the desire to be offered information concerning the rationale for ordering specific imaging examinations, intervals for follow-up imaging, and testing alternatives. Participants believed that such information should be available routinely and that conversation with their personal physician or endorsed, readily available reference materials were ideal methods for information exchange. Understanding imaging radiation risks and active participation in decision making

  1. Gastrointestinal problems in the handicapped child.

    Chong, S K


    Gastrointestinal issues are a major chronic problem in 80 to 90% of children with cerebral palsy and in children with neurodevelopmental disabilities who are at special risk of developing malnutrition because of uncoordinated swallowing, gastroesophageal reflux, and constipation. In addition to poor linear growth, there is a decrease in muscle strength and coordination, impaired cerebral function leading to decreased motivation and energy. Significant neurodevelopmental progress can be achieved with improved nutritional status. A multidisciplinary approach, with input from neurologists, gastroenterologists, nurses, occupational therapists, and dieticians, can make a major contribution to the medical wellbeing and quality of life of these children. Different neurological diseases ( eg, spinal dysraphism, syringomyelia, tethered cord syndromes) can give rise to gastrointestinal dysfunction and symptoms that may need different gastrointestinal or surgical management. The introduction of new drugs, including proton pump inhibitors and innovative endoscopic and surgical techniques in the management of gastroesophageal reflux disease and constipation also may have an impact on the treatment of neurologically handicapped children in the future.

  2. Humor as a Communication Strategy in Provider-Patient Communication in a Chronic Care Setting.

    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.

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

    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.

  4. Blood pressure differences between office and home settings among Japanese normotensive subjects and hypertensive patients.

    Mori, Hisao; Ukai, Hiroshi; Yamamoto, Hareaki; Yuasa, Shouhei; Suzuki, Yoshiro; Chin, Keiichi; Katsumata, Takuma; Umemura, Satoshi


    This study attempted to clarify the differences in blood pressure (BP) between the office (clinic) and home settings in patients with controlled, sustained, masked or white-coat hypertension. The following formula was used: office mean systolic BP (omSBP)-mean morning home SBP (mmhSBP)/office mean diastolic BP (omDBP)-mean morning home DBP (mmhDBP). The paired t-test was used for statistical analysis. The omSBP-mmhSBP/omDBP-mmhDBP calculation yielded the following results: among normotensive subjects, -1.1±11.2/-1.7±8.5 mm Hg (mean SBP and mean DBP were higher at home than in the office; n=451, P=0.038 in SBP, P=0.000 in DBP); in controlled hypertensive patients, -0.42±10.9/-2.2±8.2 mm Hg (n=1362, P=0.160 in SBP, P=0.000 in DBP); among sustained hypertensive patients, 5.6±14.7/0.048±9.9 mm Hg (n=1370, P=0.000 in SBP, P=0.857 in DBP); in masked hypertensive patients, -15.3±12.9/-9.3±9.5 mm Hg (n=1308, both P=0.000); and among white-coat hypertensive patients, 23.7±13.2/8.2±9.1 mm Hg (n=580, both P=0.000). Our results showed a difference of 5 mm Hg in SBP among sustained hypertensive patients, as recommended by the Japanese Society of Hypertension Guidelines for the Management of Hypertension; however, in other hypertensive patient types, the differences in SBP and DBP between office and home measurements differed by >5 mm Hg. Office and home BP measurements should be interpreted cautiously, keeping in mind the clinical setting.Hypertension Research advance online publication, 6 October 2016; doi:10.1038/hr.2016.125.

  5. Patient, family-centred care interventions within the adult ICU setting: An integrative review.

    Mitchell, Marion L; Coyer, Fiona; Kean, Susanne; Stone, Renee; Murfield, Jenny; Dwan, Toni


    Patient, Family-Centred Care (PFCC) is internationally advocated as a way to improve patient care. The aim of this integrative review was to extend the knowledge and understanding by synthesising empirical evidence of PFCC interventions within the adult intensive care unit (ICU) setting. An integrative review methodological framework was employed, permitting the inclusion of all research designs. A comprehensive and systematic search, selection, quality appraisal, and data extraction of research were conducted to synthesise knowledge and identify research gaps. A systematic search of the following databases was conducted: MEDLINE; CINHAL; PsycINFO; Cochrane Library; Web of Science-Current Contents Connect; Web of Science-Core Collection; The Joanna Briggs Institute EBP Database; ProQuest Sociological Abstracts; and ProQuest Dissertation and Theses Global. Primary research in adult ICUs was included. Data extracted from the studies included authors, year, country of origin, design, setting, sample, intervention, data collection strategies, main findings and limitations. Study quality was assessed using the Mixed Methods Appraisal Tool. Forty-two articles met the inclusion criteria and were included in the review. Only a third of the papers stated the theory underpinning their study. Three themes emerged with interventions predominantly around Interacting with the target sample; Culture and Connection and Service Delivery interventions were also identified. Few studies integrated more than one dimension of PFCC. Research into PFCC interventions is diverse; however, few researchers present a multi-dimensional approach incorporating a culture shift to enact PFCC throughout the ICU trajectory. There is an opportunity for future research to describe, develop, and test instruments that measure PFCC based on its multiple dimensions and not on one component in isolation. Importantly, for PFCC to successfully individualise quality patient care, a commitment and enactment of

  6. Real-world impact of education: treating patients with ipilimumab in a community practice setting

    Ledezma B


    Full Text Available Blanca Ledezma,1 Annie Heng2 1Department of Hematology and Oncology, University of California, Los Angeles, Santa Monica, CA, USA; 2Angeles Clinic and Research Institute, Los Angeles, CA, USA Abstract: After decades without promising new treatments for advanced and metastatic melanoma, ipilimumab was the first systemic therapy approved for use in this patient population. A fully human monoclonal antibody that blocks cytotoxic T-lymphocyte antigen 4 (CTLA-4 to augment antitumor T-cell responses, ipilimumab significantly extended overall survival in clinical trials. Because ipilimumab is associated with a set of immune-related adverse events that likely reflect the agent's mechanism of action, a management guide has been established. Nurses play a significant role in initially identifying these adverse reactions and assisting in patient education, treatment, and follow-up. Herein, we discuss commonly asked questions related to ipilimumab therapy and treatment of adverse events, and how nurses can be prepared to answer these questions as they arise from patients and caregivers. Keywords: melanoma, immunotherapy, patient education

  7. Life-Threatening Adenovirus Infections in the Setting of the Immunocompromised Allogeneic Stem Cell Transplant Patients

    Cedar J. Fowler


    Full Text Available A single institution case series of adenovirus infections after allogeneic hematopoietic stem cell transplantation is presented to highlight the consideration for adenovirus infections as an etiology in patients with rapid hepatic or other sudden organ deterioration in the setting of apparent GVHD stabilization. The series also highlights that survival is limited with these infections often due in part to concomitant opportunistic infections. In addition, the pathophysiological events, such as GVHD and hepatic dysfunction, may complicate the clinical picture and delay therapy of an opportunistic infection. This is particularly true for adenoviral infections as they also have a distinct clinical picture in immunocompromised patients when compared to immune competent patients. Adenovirus infections also have the additional challenge that its treatment, cidofovir, has associated toxicities that can delay its administration. Recent developments has yielded an assay that can be used in the early detection and for serial determinations of adenovirus in patients with advanced GVHD, as well as a new therapeutic agent currently undergoing clinical trials.

  8. Patients' decision-making experiences in the acute healthcare setting--a case study.

    Kalaitzidis, Evdokia


    The transition from being an ordinary citizen to a hospitalised patient can be a daunting experience particularly for the uninitiated and inexperienced. Patients are likely to have questions such as 'where do I go?', 'what should I do?', 'when?' and 'who should I ask?' The process for making practical moment-to-moment decisions is often complex and fraught with difficulties. Identifying critical points in the hospitalisation experience may provide insights into the quality of hospital management systems and professional practices from a patient perspective. This study aimed to identify institutional practices and structures in the context of acute healthcare settings which impact on patient moment-to-moment decision-making experiences. A case study approach was used as the exploratory methodology, and interviews were conducted with three former adult inpatients. In order to gain an understanding of each participant's experiences, data collecting strategies used in this research were a semistructured interview and document analysis of information documents, such as hospital supplied pamphlets, provided to the researcher by the participants. The study identified five major themes. Identified as being critical to the participants were information sharing by healthcare professionals, professional advice and professional role identification. Less so were environment and everyday life. Associated with these themes were the participant's common experience of being confined in unfamiliar surroundings, adjusting to institutional routines and of being heavily dependent on others. Findings indicate that patient moment-to-moment decision-making may be informed and enhanced in several areas: relevant and timely information sharing, varying the dress code between the different professions, reducing conflicting professional advice, clear signage around the hospital, and flexible visiting hours, telephones and clocks in patient rooms. © 2015 Nordic College of Caring Science.

  9. 嗓音障碍指数主观评估与发音障碍严重程度指数客观检测的相关性分析%Correlation between voice handicap index and voice acoustic analysis in patients with vocal cord polyps

    李晓雨; 李进让


    目的:探讨声带息肉患者嗓音障碍指数(voice handicap index,VHI)量表自我评估和发音障碍严重程度指数(dysphonia severity index,DSI)客观评估的相关性。方法取104例声带息肉患者,用VHI中文版量表进行自评及DIVAS2.5声学分析软件分析DSI,按性别、侧别、形状、大小分组比较,分析VHI和DSI的相关性。结果声带息肉的大小、形状对VHI各指标差异均无统计学意义,但较大或广基底形息肉基频微扰较重;女性患者功能、生理和VHI总体评价高于男性,但DSI却低于男性;双侧息肉比单侧在生理方面影响较重,同时DSI也较重;VHI量表各指标与嗓音声学分析各参数之间无明显相关性。结论目前临床上评估嗓音障碍程度的两种主客观方法都不理想,应进一步研究更好的评价方法。%[ABSTRACT]OBJECTIVETo investigate the relationship between self-assessment of Voice Handicap Index (VHI) and objective detection of Dysphonia Severity Index (DSI) in vocal ford polyp patients.METHODSAll 104 vocal cord polyp patients assessed the Chinese version of VHI scale by themselves. The DSI was calculated by acoustic analysis of DIVAS2.5. The correlation between VHI and DSI was analyzed in Pearson test.RESULTS There was no significant difference in each index of VHI scale score by side and shape, but the Shimmer of larger or wide-base polyps was more severe. The female patients' function, physiology, and VHI total score were higher than that of male patients, but the DSI was lower than that of male patients. The physiology score was higher in bilateral vocal cord polyp patients, so as well as DSI. There was no significant correlation between each item of VHI scale score and DSI.CONCLUSIONNeither the current subjective VHI nor objective DSI in clinical assessment of voice disorders disability is ideal, further research and better evaluation methods should be further explored.

  10. Sexual dysfunction among female patients of reproductive age in a hospital setting in Nigeria.

    Fajewonyomi, Benjamin A; Orji, Ernest O; Adeyemo, Adenike O


    Although sexual dysfunction is an important public-health problem in Nigeria, little research has been conducted on this topic in Nigeria. This cross-sectional study was conducted to determine the prevalence of sexual dysfunction and their correlates among female patients of reproductive age using a questionnaire. Respondents were recruited from the out-patients clinics of a teaching hospital setting in Ile-Ife/ Ijesa administrative health zone, Osun State, Nigeria. Of 384 female patients interviewed, 242 (63%) were sexually dysfunctional. Types of sexual dysfunction included disorder of desire (n=20; 8.3%), disorder of arousal (n=l 3; 5.4%), disorder of orgasm (n=154; 63.6%), and painful coitus (dyspareunia) (n=55; 22.7%). The peak age of sexual dysfunction was observed among the age-group of 26-30 years. Women with higher educational status were mostly affected. The reasons for unsatisfactory sexual life mainly included psychosexual factors and medical illnesses, among which included uncaring partners, present illness, excessive domestic duties, lack of adequate foreplay, present medication, competition among wives in a polygamous family setting, previous sexual abuse, and guilt-feeling of previous pregnancy termination among infertile women. The culture of male dominance in the local environment which makes women afraid of rejection and threats of divorce if they ever complain about sexually-related matters might perpetrate sexual dysfunction among the affected individuals. Sexual dysfunction is a real social and psychological problem in the local environment demanding urgent attention. It is imperative to carry out further research in society at large so that the health and lifestyles of affected women and their partners could be improved.

  11. The Patient Enablement Instrument-French version in a family practice setting: a reliability study

    Rossignol Francis


    Full Text Available Abstract Background Patient enablement can be defined as the extent to which a patient is capable of understanding and coping with his or her health issues. This concept is linked to a number of health outcomes such as self-management of chronic diseases and quality of life. The Patient Enablement Instrument (PEI was designed to measure this concept after a medical consultation. The instrument, in its original form and its translations into several languages, has proven to be reliable and valid. The purpose of this study was to evaluate the reliability of the French version of the PEI (PEI-Fv in a family practice setting. Methods One hundred and ten participants were recruited in a family medicine clinic in the Saguenay region of Quebec (Canada. The PEI-Fv was completed twice, immediately after consultation with a physician (T1 and 2 weeks after the consultation (T2. The internal consistency of the tool was assessed with Cronbach's α and test-retest reliability by intraclass correlation coefficient. Results The mean score for the PEI-Fv was 5.06 ± 3.97 (95% confidence interval [CI]: 4.30-5.81 at T1 and 4.63 ± 3.90 (95% CI: 3.82-5.44 at T2. Cronbach's α was high at T1 (α1 = 0.93; 95% CI: 0.91-0.95 and T2 (α2 = 0.93; 95% CI: 0.91-0.95. The intraclass correlation coefficient was 0.62 (95% CI: 0.48-0.74, indicating a moderate test-retest reliability. Conclusions The internal consistency of the PEI-Fv is excellent. Test-retest reliability was moderate to good. Test-retest reliability should be examined in further studies at a less than 2-week interval to reduce maturation bias. This instrument can be used to measure enablement after consultation in a French-speaking family practice setting.

  12. Development and validity of the questionnaire of patients' experiences in postacute outpatient physical therapy settings.

    Medina-Mirapeix, Francesc; Del Baño-Aledo, María Elena; Martínez-Payá, Jacinto Javier; Lillo-Navarro, María Carmen; Escolar-Reina, Pilar


    Patient feedback surveys are increasingly seen as a key component of health care quality monitoring and improvement. The study objective was to describe the development and initial psychometric evaluation of a fixed-length questionnaire about the experiences of patients receiving physical therapist treatment in postacute outpatient settings. This was an instrument development study with validity and reliability testing. A total of 465 participants attending 3 rehabilitation centers for musculoskeletal conditions completed the questionnaire. A cognitive pretest was applied to the draft version (n=94), and a revised version was evaluated for test-retest reliability (n=90). Analyses to evaluate variance and nonresponse rates for items, the factor structure of the questionnaire, and the metric properties of multi-item scales were conducted. Exploratory factor analyses yielded evidence for a 7-factor structure of the questionnaire, with 3 factors that may be conceptually viewed as professionals' attitudes and behavior (providing information and education, sensitivity to patients' changes, and emotional support) and 4 factors that conceptually reflect organizational environment (duration of attendance, interruptions during care delivery, waiting times, and patient safety). Item-scale correlations ranged from .70 to .93. The percentage of scaling success was 100% for all of the scales. Cronbach alpha coefficients ranged from .70 to .87. Intraclass correlation coefficients ranged from .57 to .80 (median=.68). Generalization to other patients is not known. The questionnaire has test-retest reliability, and the scales have internal consistency and convergent and discriminant validity. All of the scales are distinct and unidimensional. © 2015 American Physical Therapy Association.

  13. Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.

    Christen Lykkegaard Andersen

    Full Text Available BACKGROUND: Several studies have demonstrated an association between rheumatoid arthritis (RA and lymphoproliferative malignancies, but pathogenic mechanisms remain unclear. We investigated 1 the risk of lymphoproliferative malignancies and solid tumors in adults with RA identified in primary care and 2 the possible mediating role of blood eosinophilia in the clonal evolution of cancer in these patients. METHODS: From the Copenhagen Primary Care Differential Count (CopDiff Database, we identified 356,196 individuals with at least one differential cell count (DIFF encompassing the eosinophil count between 2000-2007. From these, one DIFF was randomly chosen (the index DIFF. By linking to the Danish National Patient Register, we categorized the selected individuals according to known longstanding (≥3 years or recent onset (<3 years RA prior to the index DIFF. In addition, the cohort was stratified according to management in primary or secondary care. From the Danish Cancer Registry we ascertained malignancies within four years following the index DIFF. Using multivariable logistic regression, odds ratios (OR were calculated and adjusted for sex, age, year, month, eosinophilia, comorbid conditions and C-reactive protein (CRP. RESULTS: 921 patients had recent onset RA and 2,578 had longer disease duration. Seventy three percent of RA patients were managed in primary care. After adjustment for sex, age, year, and month, neither recent onset nor long-standing RA was associated with incident 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 risk of lymphoproliferative or solid cancers during 4 years of follow-up, when the models were adjusted for confounders. Blood eosinophilia could not

  14. Correlation between Voice Handicap Index-10(VHI-10) and Voice Acoustic Analysis in Patients with Unilateral Arytenoid Dislocation%单侧环杓关节脱位患者嗓音声学分析与VHI-10的相关性研究

    马艳利; 徐新林; 侯光辉; 周莉; 庄佩耘


    Objective To study the relationship between voice acoustic analysis(VAA)and voice handicap index-10(VHI-10) in patients with unilateral arytenoid dislocation and to investigate the characteristic of the VHI-10. Methods 50 subjects with normal voice and 36 patients with unilateral arytenoid dislocation were tested by VAA and VHI-10. VAA include jitter、shimmer、F0 and NHR. The total score of VHI-10 recorded as Tvh. Results ①There were significant differences in jitter、shimmer、F0、NHR and VHI-10 between unilateral arytenoid dislocation group and control group. ②There was no correlation between all acoustic parameters and VHI-10 in male. All acoustic parameters except F0 had significant correlations with VHI-10 in female and the correlation coefficient were 0.556, 0.556 and 0.719. Conclusion The acoustic parameters are effective parameters to measure the voice quality of patients with unilateral arytenoid dislocation. Unilateral arytenoid dislocation significantly affects the quality of life in patients. However, the different of sex will result in the effect on the quality of life in patients inconsistently.%目的:探讨嗓音声学分析与简化嗓音障碍指数(voice handicap index-10,VHI-10)用于单侧环杓关节脱位患者嗓音质量评估的临床意义及其相关性。方法对36例(男性20例,女性16例)单侧环杓关节脱位患者和50例(男性25例,女性25例)嗓音正常者进行嗓音声学分析和VHI-10调查。嗓音声学参数包括基频微扰(jitter)、振幅微扰(shimmer)、基频(F0)和噪谐比(NHR);VHI-10调查记录总分值Tvh。结果①单侧环杓关节脱位组的jitter、shimmer、NHR、F0和VHI-10与对照组比较差异均有统计学意义。②男性单侧环杓关节脱位组患者嗓音声学分析参数jitter、shimmer、NHR和F0与VHI-10之间无相关性;女性患者组,除F0与VHI-10之间无相关性外,其余3个jitter、shimmer、NHR与VHI-10之间均有相关

  15. [Attitudes towards patient safety culture in a hospital setting and related variables].

    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.

  16. Prevalence of peripheral arterial disease in patients with diabetes mellitus in a primary care setting.

    Rabia, K; Khoo, E M


    The aims of the study were to determine the prevalence of peripheral arterial disease (PAD) in diabetic patients and in different ethnic groups at a primary care setting, and to evaluate risk factors associated with PAD in these diabetic patients. A cross sectional study of 200 diabetic patients over 18 years old who attended a primary care clinic at a teaching hospital in Kuala Lumpur, Malaysia was carried out. Face-to-face interviews were conducted using structured questionnaires for demographic characteristics and risk factors evaluation. Blood pressure measurements, assessment of peripheral neuropathy and ankle brachial pressures were performed. PAD was diagnosed by an ankle brachial pressure index (ABPI) of <0.9 on either leg. The overall prevalence of PAD was 16% in this diabetic population. The prevalence of PAD was 5.8% in Malays, 19.4% in Chinese and 19.8% in Indians. The prevalence of peripheral neuropathy was 41%, foot ulcer 9.5%, and gangrene 3.0%. The presence of foot ulcer was weakly associated with PAD (P=0.052). No significant relationships were found between age, gender, smoking status, duration of diabetes mellitus, hypertension, dyslipidaemia, and PAD. PAD is common in the diabetic population of this study.

  17. How staff and patient experience shapes our perception of spiritual care in a psychiatric setting.

    Raffay, Julian


    To explore how our understanding of care practice is shaped by the extent of our engagement with staff and patient experience. In spite of the fact that service users desire good spiritual care and that government guidelines recognize its importance, frontline staff in psychiatric settings often find current spiritual assessment tools hard to use and the concept of spirituality difficult to comprehend. A database search was conducted, the grey literature analysed, spirituality assessment tools were explored, and an approach based on user experience was considered. Each of these four perspectives resulted in different perceptions of care. By engaging patient and staff experience, we begin to see spiritual care very differently. There may be rich opportunities for research into the lived experience of the support systems that service users create for each other on wards when they experience staff as inaccessible. Deeper engagement with patients and staff and their concerns is likely to result in breakthroughs in both the understanding and the practice of spiritual care as well as potentially other areas of nursing care. © 2013 John Wiley & Sons Ltd.

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

    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.

  19. ASHP national survey of pharmacy practice in hospital settings: Monitoring and patient education--2009.

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J


    Results of the 2009 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented. A stratified random sample of pharmacy directors at 1364 general and children's medical-surgical hospitals in the United States were surveyed by mail. SDI Health supplied data on hospital characteristics; the survey sample was drawn from SDI's hospital database. The response rate was 40.5%. Virtually all hospitals (97.3%) had pharmacists regularly monitor medication therapy in some capacity; nearly half monitored 75% or more of their patients. Over 92% had pharmacists routinely monitor serum medication concentrations or their surrogate markers, and most hospitals allowed pharmacists to order initial serum concentrations (80.1%) and adjust dosages (79.2%). Interdisciplinary committees reviewed adverse drug events in 89.3% of hospitals. Prospective analysis was conducted by 66.2% of hospitals, and retrospective analysis was performed by 73.6%. An assessment of safety culture had been conducted by 62.8% of hospitals. Most hospitals assigned oversight for patient medication education to nursing (89.0%), but many hospitals (68.9%) reported that pharmacists provided medication education to 1-25% of patients. Computerized prescriber-order-entry systems with clinical decision support were in place in 15.4%, bar-code-assisted medication administration systems were used by 27.9%, smart infusion pumps were used in 56.2%, and complete electronic medical record systems were in place in 8.8% of hospitals. The majority of hospitals (64.7%) used an integrated pharmacy practice model using clinical generalists. Pharmacists were significantly involved in monitoring medication therapy. Pharmacists were less involved in medication education activities. Technologies to improve the use of medications were used in an increasing percentage of hospitals. Hospital pharmacy practice was increasingly integrated, with pharmacists having both

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

    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.

  1. Reliability and validity of the Dutch pediatric Voice Handicap Index.

    Veder, Laura; Pullens, Bas; Timmerman, Marieke; Hoeve, Hans; Joosten, Koen; Hakkesteegt, Marieke


    The pediatric voice handicap index (pVHI) has been developed to provide a better insight into the parents' perception of their child's voice related quality of life. The purpose of the present study was to validate the Dutch pVHI by evaluating its internal consistency and reliability. Furthermore, we determined the optimal cut-off point for a normal pVHI score. All items of the English pVHI were translated into Dutch. Parents of children in our dysphonic and control group were asked to fill out the questionnaire. For the test re-test analysis we used a different study group who filled out the pVHI twice as part of a large follow up study. Internal consistency was analyzed through Cronbach's α coefficient. The test-retest reliability was assessed by determining Pearson's correlation coefficient. Mann-Whitney test was used to compare the scores of the questionnaire of the control group with the dysphonic group. By calculating receiver operating characteristic (ROC) curves, sensitivity and specificity we were able to set a cut-off point. We obtained data from 122 asymptomatic children and from 79 dysphonic children. The scores of the questionnaire significantly differed between both groups. The internal consistency showed an overall Cronbach α coefficient of 0.96 and an excellent test-retest reliability of the total pVHI questionnaire with a Pearson's correlation coefficient of 0.90. A cut-off point for the total pVHI questionnaire was set at 7 points with a specificity of 85% and sensitivity of 100%. A cut-off point for the VAS score was set at 13 with a specificity of 93% and sensitivity of 97%. The Dutch pVHI is a valid and reliable tool for the assessment of children with voice problems. By setting a cut-off point for the score of the total pVHI questionnaire of 7 points and the VAS score of 13, the pVHI might be used as a screening tool to assess dysphonic complaints and the pVHI might be a useful and complementary tool to identify children with dysphonia

  2. Detection of benign proliferative lesions on vocal cords with voice handicap index.

    Huang, Xuekun; Zhang, Gehua; Liu, Xiujin; Wang, Tao; Zhu, Ling


    The aim of this study was to investigate the significance and practical applicability of the voice handicap index (VHI) in the diagnosis of benign proliferative lesions of the vocal cords (BLVCs). The detection of VHI included the calculation of functional (F), physical (P) and emotional (E) domains, and the score of each domain and total score (TVH). The VHI was scored in patients with BLVCs and healthy controls. Eighty-four patients with BLVCs and 27 healthy controls were enrolled in the present study. The F, P, E and TVH scores were 10.40±7.84, 19.88±8.81, 9.39±8.49 and 39.37±21.83, respectively, in the BLVC group and 0.78±0.97, 0.85±1.06, 0.26±0.72 and 1.89±2.31, respectively, in the control group. A significant difference was found between the two groups (PVHI score in BLVC patients (P>0.05). There was no marked difference in the VHI score between voice-consuming and non-voice consuming occupations (P>0.05) or between males and females (P>0.05). In BLVC patients, VHI may subjectively express the voice handicap, while daily duration of speech, course of BLVC, occupation and gender have no impact on VHI.

  3. The School-Age Handicapped. A Statistical Profile of Special Education Students in Elementary and Secondary Schools in the United States. Contractor Report.

    Zill, Nicholas

    The report presents an analysis of the size and composition of the school age handicapped population, the numbers and types of teachers providing education to them, the settings and accessibility of school facilities, and the levels of federal funding. The report notes the lack of available data on many national issues. Among major findings…

  4. [Set up of a protocol for heparin use in special patients].

    Manresa Ramón, N; Nájera Pérez, Ma D; Page del Pozo, Ma Ángeles; Sánchez Martínez, I; Sánchez Catalicio, Ma del M; Roldán Schilling, V


    Low-molecular weight (LMW) heparins bring a series of advantages as compared to non-fractionated heparin (NFH), such as safety, efficacy, bioavailability, fewer monitoring, and persistent anti-coagulant response. There exist, however, a concern about their use in particular patients that may require a special control, such as those with renal failure, age over 75 years, obesity, and pregnancy. The aim of this study was the set up between the department of Pharmacy, Hematology, and Internal Medicine of a consensus protocol for the follow-up ad monitoring of LMWH in patients requiring a special control. For this purpose, we carried out a bibliographical review of the different heparins used under de above mentioned conditions. Based on the evidence available and the consensus among the members of the working group, we established a protocol that contained recommendations on prophylaxis, management and monitoring by means of the determination of anti-Xa factor. Besides, we included some clues on the therapeutic figures of anti-Xa and administration schedules for obtaining anti-Xa values within the range. Enoxaparin was the selected heparin given the evidence and its availability at our center.

  5. Improper sharp disposal practices among diabetes patients in home care settings: Need for concern?

    Anindo Majumdar


    Full Text Available In the recent years, outbreaks of blood-borne infections have been reported from assisted living facilities, which were traced back to improper blood glucose monitoring practices. Needle-stick injuries have been implicated in many such cases. This directly raises concerns over sharp disposal practices of diabetic patients self-managing their condition in home care settings. With India being home to a huge diabetic population, this issue, if neglected, can cause substantial damage to the health of the population and a marked economic loss. This article discusses the sharp disposal practices prevalent among diabetes patients, the importance of proper sharp disposal, barriers to safe disposal of sharps, and the options available for doing the same. For adopting an environmentally safe wholesome approach, disposal of plastics generated as a result of diabetes self-care at home is important as well. The article also looks at the possible long-term solutions to these issues that are sustainable in an Indian context.

  6. Siblings of Handicapped Children: Assessing the Need for and Impact of Their Early Education. Final Report.

    Lobato, Debra; Miller, Carol T.

    The project examined the psychosocial functioning of preschool-aged siblings of handicapped children in comparison to a matched control group of siblings of non-handicapped children. The project then examined the psychosocial effects of increasing sibling understanding of and involvement with the handicapped child via participation in a 6-week…

  7. The Integration of the Handicapped into the Regular Classroom: Effects of Cooperative and Individualistic Instruction.

    Johnson, David W.; Johnson, Roger T.


    The effects of cooperative and individualistic learning experiences on interpersonal attraction between handicapped and nonhandicapped fourth graders were compared. Students were assigned to conditions on a stratified random basis controlling for handicap, ability, and sex. Cooperative experiences promoted more cross-handicapped interaction and…

  8. 13 CFR 113.3-3 - Structural accommodations for handicapped clients.


    ... 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...

  9. 48 CFR 552.238-70 - Identification of Electronic Office Equipment Providing Accessibility for the Handicapped.


    ... Electronic Office Equipment Providing Accessibility for the Handicapped. 552.238-70 Section 552.238-70... Equipment Providing Accessibility for the Handicapped. As prescribed in 538.273(a)(1), insert the following clause: Identification of Electronic Office Equipment Providing Accessibility for the Handicapped...

  10. 24 CFR 100.202 - General prohibitions against discrimination because of handicap.


    ... discrimination because of handicap. 100.202 Section 100.202 Housing and Urban Development Regulations Relating to... Against Discrimination Because of Handicap § 100.202 General prohibitions against discrimination because of handicap. (a) It shall be unlawful to discriminate in the sale or rental, or to otherwise...

  11. 41 CFR 50-202.3 - Learners, student learners, apprentices, and handicapped workers.


    ... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Learners, student learners, apprentices, and handicapped workers. 50-202.3 Section 50-202.3 Public Contracts and Property... handicapped workers. Learners, student learners, apprentices, and handicapped workers may be employed at...

  12. 24 CFR 235.331 - Increased maximum mortgage amount for physically handicapped persons.


    ... for physically handicapped persons. 235.331 Section 235.331 Housing and Urban Development Regulations... maximum mortgage amount for physically handicapped persons. If the mortgage relates to a dwelling unit to be occupied by a handicapped person as defined in § 235.5(c)(2), the otherwise applicable...

  13. 38 CFR 17.152 - Devices to assist in overcoming the handicap of deafness.


    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Devices to assist in overcoming the handicap of deafness. 17.152 Section 17.152 Pensions, Bonuses, and Veterans' Relief DEPARTMENT... in overcoming the handicap of deafness. Devices for assisting in overcoming the handicap of...

  14. Problems Faced by Physical Handicapped Students in Educational Institutions in District Kohat

    Hussain, Ishtiaq; Bashir, Muhammad; ud Din, Muhammad Naseer; Butt, Muhammad Naeem; Akhter, Shagufa; Inamullah, Hafiz


    The purpose of the study was to explore the problems faced by physical handicapped students in normal educational institutions and to find solutions to the problems faced by physical handicapped students. All the physical handicapped students studying in educational institutions in District Kohat constituted the population of the study. The study…

  15. The patient’s perspective of the feasibility of a patient-specific instrument in physiotherapy goal setting: a qualitative study


    Background: Patient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goal-setting process because patients can identify and rate their own problems. The aim of this study is to explore patients’ experiences with the feasibility of the PSC, in the physiotherapy goal setting. Method: We ...

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

    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%.

  17. Staphylococcus aureus bacteraemia in a tropical setting: patient outcome and impact of antibiotic resistance.

    Emma K Nickerson

    Full Text Available BACKGROUND: Most information on invasive Staphylococcus aureus infections comes from temperate countries. There are considerable knowledge gaps in epidemiology, treatment, drug resistance and outcome of invasive S. aureus infection in the tropics. METHODS: A prospective, observational study of S. aureus bacteraemia was conducted in a 1000-bed regional hospital in northeast Thailand over 1 year. Detailed clinical data were collected and final outcomes determined at 12 weeks, and correlated with antimicrobial susceptibility profiles of infecting isolates. PRINCIPAL FINDINGS: Ninety-eight patients with S. aureus bacteraemia were recruited. The range of clinical manifestations was similar to that reported from temperate countries. The prevalence of endocarditis was 14%. The disease burden was highest at both extremes of age, whilst mortality increased with age. The all-cause mortality rate was 52%, with a mortality attributable to S. aureus of 44%. Methicillin-resistant S. aureus (MRSA was responsible for 28% of infections, all of which were healthcare-associated. Mortality rates for MRSA and methicillin-susceptible S. aureus (MSSA were 67% (18/27 and 46% (33/71, respectively (p = 0.11. MRSA isolates were multidrug resistant. Only vancomycin or fusidic acid would be suitable as empirical treatment options for suspected MRSA infection. CONCLUSIONS: S. aureus is a significant pathogen in northeast Thailand, with comparable clinical manifestations and a similar endocarditis prevalence but higher mortality than industrialised countries. S. aureus bacteraemia is frequently associated with exposure to healthcare settings with MRSA causing a considerable burden of disease. Further studies are required to define setting-specific strategies to reduce mortality from S. aureus bacteraemia, prevent MRSA transmission, and to define the burden of S. aureus disease and emergence of drug resistance throughout the developing world.

  18. Validation and Adaptation of the Singing Voice Handicap Index for Egyptian Singing Voice.

    Abou-Elsaad, Tamer; Baz, Hemmat; Afsah, Omayma; Abo-Elsoud, Hend


    Measuring the severity of a voice disorder is difficult. This can be achieved by both subjective and objective measures. The Voice Handicap Index is the most known and used self-rating tool for voice disorders. The Classical Singing Handicap Index (CSHI) is a self-administered questionnaire measuring the impact of vocal deviation on the quality of life of singers. The objective of this study was to develop an Arabic version of the CSHI and to test its validity and reliability in Egyptian singers with different singing styles with normal voice and with voice disorders. The interpreted version was administered to 70 Egyptian singers including artistic singers (classical and popular) and specialized singers (Quran reciters and priests) who were divided into 40 asymptomatic singers (control group) and 30 singers with voice disorders. Participants' responses were statistically analyzed to assess the validity and reliability, and to compare the patient group with the control group. Quran reciters, patients with no previous professional training, and patients with vocal fold lesions demonstrated the highest scores. The Arabic version of CSHI is found to be a reliable, valid, and sensitive self-assessment tool that can be used in the clinical practice for the evaluation of the impact of voice disorders on singing voice. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  19. International Classification of Functioning, Disability and Health (ICF) Core Set for patients with vertigo, dizziness and balance disorders.

    Grill, Eva; Bronstein, Adolfo; Furman, Joseph; Zee, David S; Müller, Martin


    Vertigo, dizziness and balance disorders have major impact on independence, employability, activities and participation. There are many measures for the assessment of the impact of vertigo, but no consensus exists on which aspects should be measured. The objective of this study was to develop international standards (ICF Core Sets) for patients with vertigo and dizziness to describe functioning. The development of the ICF Core Sets involved a formal decision-making and consensus process, integrating evidence from preparatory studies including qualitative interviews with patients, a systematic review of the literature, a survey with health professionals, and empirical data collection from patients. Twenty-seven experts selected 100 second level categories for the comprehensive Core Set and 29 second level categories for the Brief Core Set. The largest number of categories was selected from the ICF component Activities and Participation (40). Twenty-five categories were selected from the component Body Functions, six from Body Structures, and 29 from Environmental Factors. The ICF Core Set for vertigo is designed for physicians, nurses, therapists and other health professionals working in inpatient or ambulatory settings. ICF Core Sets create patient-relevant outcomes that can be used as evidence for the success of treatments.

  20. Validation of the "Activity and participation" component of ICF Core Sets for stroke patients in Japanese rehabilitation wards

    Kinoshita, Shoji; Abo, Masahiro; Miyamura, Kohei; Okamoto, Takatsugu; Kakuda, Wataru; Kimura, Ikuo; Urabe, Hiroshi


    To validate the International Classification of Functioning, Disability and Health (ICF) Core Set for stroke in the assessment of functional status and disability in Japanese stroke patients. The study included stroke patients admitted to the Kaifukuki (convalescent) rehabilitation wards. The comprehensive ICF Core Set for neurological conditions for post-acute care and the ICF rehabilitation set were evaluated with qualifiers assessed by the physiatrists at admission. The "activity and participation" (d) component was divided to sub-components (cognition-related activity, motor-related activity and participation). The correlations between numbers of problem categories in the entire "d" component and these sub-components in each ICF Core Set and the Functional Independence Measure (FIM) score were assessed using Spearman's correlation coefficient. A total of 117 post-stroke patients (mean age 70.1 ± 14.2 years, 53 women) were included. Correlation analysis identified significant and strong correlations between the values of the entire "d" component and sub-components (cognition-related activity and motor-related activity) of the 2 ICF Core Sets and FIM score. A significant, but weak, correlation between FIM and the participation sub-component was identified. The "d" component of these 2 ICF Core Sets reflects functional status and disability and could be a valid measure in post-acute stroke patients in the rehabilitation setting.

  1. Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice

    Dillen, van S.; Noordman, J.; Dulmen, van S.; Hiddink, G.J.


    Objective Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight

  2. Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice

    Dillen, S.M. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.


    OBJECTIVE: Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight

  3. Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice.

    Dillen, S.M.E. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.


    Objective: Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight

  4. Drug-adherence questionnaires not valid for patients taking blood-pressure-lowering drugs in a primary health care setting.

    Steeg, N. van de; Sielk, M.; Pentzek, M.; Bakx, C.; Altiner, A.


    PURPOSE: To validate two established questionnaires [Morisky and Medication Adherence Report Scale (MARS-5)] for the measurement of medical adherence of patients treated with antihypertensive drugs in primary care in Germany. SETTING: General practitioners (GPs) and their patients in North Rhine-Wes

  5. Patients' preference for exercise setting and its influence on the health benefits gained from exercise-based cardiac rehabilitation

    Tang, Lars H.; Berg, Selina Kikkenborg; Christensen, Jan


    OBJECTIVE: To assess patient preference for exercise setting and examine if choice of setting influences the long-term health benefit of exercise-based cardiac rehabilitation. METHODS: Patients participating in a randomised controlled trial following either heart valve surgery, or radiofrequency......% 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...... 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....

  6. ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education--2012.

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J


    The results of the 2012 American Society of Health-System Pharmacists national survey of pharmacy practice in U.S. hospital settings are presented. A stratified random sample of pharmacy directors at 1413 general and children's medical-surgical hospitals were surveyed by mail. SDI Health supplied data on hospital characteristics; the survey sample was drawn from SDI's hospital database. In this national probability sample survey, the response rate was 34.0%. The rate of pharmacist monitoring of most patients (i.e., >75%) in hospitals has increased, from 20.3% in 2000 to 46.5% in 2012. Therapeutic drug monitoring programs are in place at most hospitals; at more than 80% of hospitals, pharmacists have the authority to order laboratory tests and adjust medication dosages. A safety culture assessment has been conducted at 72.4% of hospitals. Pharmacists routinely perform discharge counseling in 24.7% of hospitals. At most hospitals, nurses are primarily responsible for medication reconciliation, but 65.9% of pharmacy directors would like pharmacy to have this responsibility. Computerized prescriber order entry is now used in 54.4% of hospitals, with barcode-assisted medication administration used in 65.5% and smart pumps used in 77% of hospitals. The majority of hospitals have fully or partially implemented electronic health records. An increase in the use of remote pharmacist review of medication orders has reduced the percentage of hospitals where orders are not reviewed before a dose is administered to 32%. Pharmacists continue to improve medication use in U.S. hospitals through patient monitoring and education, safety initiatives, collaborative practices with other health care professionals, assisting in the adoption of technologies, and the provision of pharmacy services to outpatients.

  7. Assessing quality of care of elderly patients using the ACOVE quality indicator set: a systematic review.

    Marjan Askari

    Full Text Available BACKGROUND: Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE quality indicators (QIs were developed to assess and improve the care of elderly patients. OBJECTIVES: The purpose of this review is to summarize studies that assess the quality of care using QIs from or based on ACOVE, in order to evaluate the state of quality of care for the reported conditions. METHODS: We systematically searched MEDLINE, EMBASE and CINAHL for English-language studies indexed by February 2010. Articles were included if they used any ACOVE QIs, or adaptations thereof, for assessing the quality of care. Included studies were analyzed and relevant information was extracted. We summarized the results of these studies, and when possible generated an overall conclusion about the quality of care as measured by ACOVE for each condition, in various settings, and for each QI. RESULTS: Seventeen studies were included with 278 QIs (original, adapted or newly developed. The quality scores showed large variation between and within conditions. Only a few conditions showed a stable pass rate range over multiple studies. Overall, pass rates for dementia (interquartile range (IQR: 11%-35%, depression (IQR: 27%-41%, osteoporosis (IQR: 34%-43% and osteoarthritis (IQR: 29-41% were notably low. Medication management and use (range: 81%-90%, hearing loss (77%-79% and continuity of care (76%-80% scored higher than other conditions. Out of the 278 QIs, 141 (50% had mean pass rates below 50% and 121 QIs (44% had pass rates above 50%. Twenty-three percent of the QIs scored above 75%, and 16% scored below 25%. CONCLUSIONS: Quality of care per condition varies markedly across studies. Although there has been much effort in improving the care for elderly patients in the last years, the reported quality of care according to the ACOVE indicators is still relatively low.

  8. Psychosocial Characteristics of Preschool Siblings of Handicapped and Nonhandicapped Children.

    Lobato, Debra; And Others


    The study examined psychosocial characteristics of 24 siblings of handicapped children (ages 3-7) in relation to a control group of 22 siblings of nonhandicapped children. Results indicated no statistically significant differences between groups on measures of perceived self-competence and acceptance, understanding of developmental disabilities,…

  9. A Model of Services for Young Handicapped Children.

    Jelinek, Janis A.


    The paper describes a model of services for 38 infants and young children whose primary handicap was a communication disorder or for whom a communication disorder was a related problem. Data indicated that the model was effective in producing child growth in receptive and expressive language, as well as other developmental areas. (Author/CL)

  10. The Doman-Delacato Treatment of Neurologically Handicapped Children.

    Exceptional Parent, 1983


    The policy statement of the American Academy of Pediatrics on the Doman-Delacato approach to treating children with neurological handicaps cites lack of reseach support for the method and concludes that its demands may overburden families without achieving progress that would not be accounted for by growth and development. (CL)

  11. Signal modulation as a mechanism for handicap disposal

    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. Handicap, beskæftigelse og uddannelse i 2016

    Larsen, Malene Rode; Larsen, Mona

    Denne rapport afdækker, hvor stor en del af den danske befolkning i alderen 16 til 64 år, der har et handicap eller et længerevarende helbredsproblem. I forlængelse heraf undersøger rapporten en lang række forhold relateret til denne gruppes tilknytning til arbejdsmarkedet. Rapporten belyser for ...

  13. Demographic and audiological factors as predictors of hearing handicap

    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.

  14. Educable Mentally Handicapped - Programs: Exceptional Child Bibliography Series.

    Council for Exceptional Children, Reston, VA. Information Center on Exceptional Children.

    One in a series of over 50 similar listings relating to handicapped and gifted children, the bibliography contains 100 references selected from Exceptional Child Education Abstracts concerning programs for the educable mentally retarded. Bibliographic data, availability information, indexing and retrieval descriptors, and an abstract are included…

  15. Vocational Education of Handicapped Students: A Guide for Policy Development.

    Davis, Sharon; Ward, Michael

    Designed to assist state and local educational agencies and intermeidate educational units in developing administrative policies for the vocational education of handicapped students, the manual address present policy areas and administrative concerns. Guidelines are presented for policy development in the following nine areas (examples of…

  16. The education of physically handicapped children in normal schools.

    Barry, C; Garvey, C; Byrne, M M


    This paper is based on our experience in the Central Remedial Clinic over a number of years that physically handicapped children do not in general do well in ordinary schools. An attempt is made to delineate some of the problems that may confront a handicapped child of generally average intelligence who attends a normal school. These problems are associated with the following conditions: specific learning difficulties, emotional problems, poor school attendance, large classes, limitations in ordinary teacher training and lack of remedial teachers and other special staff. The need for early and continued psychological and educational assessments is emphasized, and it is suggested that most young physically handicapped children of average intelligence would benefit from starting in a special assessment unit, to ensure as far as possible, correct school placement. This view is not currently held by a number of educational authorities who generally advise that physically handicapped children should go to ordinary schools if possible. We feel that this advice is not always in the best interests of the child. There is need for continuing friendly and informal communications between parents and members of the special school team.

  17. Relaxation Techniques for Handicapped Children: A Review of Literature.

    Zipkin, Dvora


    The paper discusses four major relaxation training approaches used with handicapped children: progressive muscle relaxation, biofeedback, yoga, and mental relaxation, which includes guided fantasy, imagery, and meditation. Descriptions of these techniques, the effects of their use with various populations, and reviews of recent studies of their…

  18. Employment Rights of Handicapped Individuals: Statutory and Judicial Parameters.

    Massaro, Toni M.


    Analyzes existing legislation, regulations, and case law interpreting statutory mandates to provide a survey of the current status of employment rights for the handicapped. Suggests an administrative framework to alleviate weaknesses in existing governmental programs. Available from Marshall-Wythe School of Law of the College of William and Mary,…

  19. Synchronic Distance Education from the Perspective of a Handicapped Person

    Karal, Hasan; Cebi, Ayca; Turgut, Yigit Emrah


    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…

  20. The Focus of Attention Is on the Handicapped College Student

    Zaitsev, D. V.


    As a social institution, higher education constitutes one of the most important factors that enable an individual's mobility. In the past few years, both specialists and the broader public have been addressing the problem of how people with health limitations and handicaps can acquire an education. In part this is because society and the state…

  1. Some Personality Characteristics of Self-Handicapping Behavior.

    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…

  2. Classroom Centers for Multiple Handicapped Children 1972-1975.

    Grigsby, Camilla

    The Classroom Centers for Multiple Handicapped Children were designed to provide profoundly retarded children with instructional programs meeting individual needs. In addition to the educational and training components of the program, speech and physical therapy services were also included. Seven classroom centers served approximately 56 children…

  3. Cognitive-Behavioral Training in Spelling for Learning Handicapped Students.

    Gerber, Michael M.; Hall, Robert J.


    Development of effective cognitive-behavioral training approaches for students with learning handicaps in academic domains, such as spelling, requires greater concern for teachers' knowledge of the academic domain, as well as their pedagogical expertise in finely and precisely adjusting their instructional use of language to communicate that…

  4. Orthopaedically Handicapped Students in Public and Private High Schools.

    Gregory, James F.; And Others


    Orthopedically handicapped (OH, N=353) twelfth graders were compared to a control group. Blacks were under-represented in the OH cohort, and OH students had a higher incidence of other impairments. Academically the OH teenagers performed competitively with classmates, though they experienced difficulties in self-esteem, locus of contrtol, and…

  5. Exceptional Children Conference Papers: Education of the Educable Mentally Handicapped.

    Council for Exceptional Children, Arlington, VA.

    Nine conference papers focus on education of educable mentally handicapped (EMH) children. A prototype evaluation of procedures for teaching reading comprehension involves assessment of 96 EMH or normal students' skills in identifying main and supporting ideas in connected discourse. Described is the Lincoln School's behavioral management system…

  6. Curricular Guidelines for Dental Hygiene Care for the Handicapped.

    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. A Family Oriented Enrichment Program for Handicapped Infants.

    Furuno, Setsu; O'Reilly, Kitty

    This report describes a program for handicapped infants which emphasizes early treatment as a prime means of preventing more serious physical and behavioral problems later in life. Also, the program focuses on the entire family of the developmentally disabled, including infant, parents, and siblings. Program objectives include (1) increased…

  8. Swimming for the Handicapped: A Manual for the Aide.

    Priest, Louise

    Presented is the American National Red Cross Swimming for the Handicapped Program manual designed for volunteer aides. The program's aims, scope, and value are described in the introduction. It is noted that the nonswimming aides can play a vital role in transportation, dressing room assistance, record keeping, and as safety assistants, while…

  9. Using Your Daily Newspaper to Teach the Mentally Handicapped.

    Loo, Mee Quai P.

    One of a series prepared by the Hawaii Newspaper Agency, this teaching guide offers suggestions on using the newspaper to teach the mentally handicapped. Classroom activities include the use of graffiti, pictures, comics, color, and charts, as well as speech activities, debate issues, history, creative or make up contests, anthropology,…

  10. Educational Technology for the Severely Handicapped: A Comprehensive Bibliography.

    Gaines, Debby, Comp.; And Others

    The bibliography presents approximately 650 references (1955-1975) on educational programs for the severely handicapped. Citations are listed alphabetically by author's name in the following areas: behavior management, curriculum guides, medico-prosthetic aids, motor development, parent training (including aspects of parent involvement in school…

  11. Early Childhood Program for the Handicapped in France.

    Zucman, Elisabeth


    Early intervention in France begins with compulsory screening of all infants at birth, nine months, and at two years. Problems remain, especially in the availability of adequate support and of services for the handicapped child. Interdisciplinary teams operate from "early medico-social activity centers" to provide a variety of…

  12. Sygemeldte og førtidspensionister med handicap

    Tørslev, Mette Kirstine; Weibel, Kristina; Høgelund, Jan


    sygedagpengemodtagere og førtidspensionister med handicap igangsat af Vidensnetværket, som er forankret i Danske Handicaporganisationer. Arbejdspapiret er udarbejdet af forskningsassistent, cand.mag. (antropologi) Mette Kristine Tørslev, forskningsassistent, cand.scient.soc. Kristina Weibel og seniorforsker, cand...

  13. Voice-controlled Internet Browsing for Motor-handicapped Users

    Brøndsted, Tom; Aaskoven, Erik


    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...

  14. Uses of the HOME Inventory for Families with Handicapped Children.

    Bradley, Robert H.; And Others


    The usefulness and validity of the 3 versions (Infant-Toddler, Early Childhood, and Middle Childhood) of the HOME Inventory were studied with 261 children with cognitive, hearing, vision, or orthopedic handicaps. The Inventory in its original form and a modified form was subjected to analysis of reliability, construct validity, and criterion…

  15. Videophone to improve communication between intellectual handicapped and their relatives

    Deverson, Melinda M.C.E.; Spil, Antonius A.M.; van Gemert-Pijnen, Julia E.W.C.


    The aim of this study is to evaluate the use of a videophone by people with an intellectual handicap and their relatives at a healthcare organisation in the Netherlands. A triangulation of methods is used. The first method was a questionnaire (pre-study) were 195 clients and 439 client

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

    Faheem, Muhammad; Fahim, Ammad; Innocent, Haran; Mansoor, Zainab; Rizvi, Shehrbano; Farrukh, Hizra


    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. PMID:27752508

  17. Seclusion room vs. physical restraint in an adolescent inpatient setting: patients' attitudes.

    Vishnivetsky, Sergey; Shoval, Gal; Leibovich, Vadim; Giner, Lucas; Mitrany, Marsel; Cohen, Dorit; Barzilay, Aliza; Volovick, Louisa; Weizman, Abraham; Zalsman, Gil


    The use of physical restraints or a seclusion room for the treatment of adolescents in a psychiatric inpatient setting raises ethical dilemmas. We investigated the attitudes of adolescents towards these two means of confinement. We used a structured questionnaire to collect data on the attitudes of 50 adolescent patients, hospitalized in a closed psychiatric ward, towards the use of physical restraint versus a seclusion room. Seventy per cent of the participants in the study preferred seclusion in the seclusion room over bed restraint, whereas 22% preferred physical restraint. Eighty-two percent described seclusion in the seclusion room as less frightening than restraint. Seventy-four per cent reported that seclusion in the seclusion room improved their mental state to a larger extent than restraint. The inpatient adolescents reported feeling the time they needed to reach a state of calm was shorter when they were confined to the seclusion room than when they were physically restrained (p>.001). The use of a seclusion room may be preferable compared to physical restraint for inpatient adolescents.

  18. Trust in the physician-patient relationship in developing healthcare settings: a quantitative exploration.

    Gopichandran, Vijayaprasad; Chetlapalli, Satish Kumar


    Trust in physicians is the patient's optimistic acceptance of vulnerability and the expectation that the physician will do what is best for his/her welfare. This study was undertaken to develop a conceptual understanding of the dimensions and determinants of trust in physicians in healthcare settings in resource-poor, developing countries. A cross-sectional household survey was conducted on a sample of 625 men and women from urban and rural areas in Tamil Nadu, India. The sample was selected using a multistage sampling method and a pre-tested structured questionnaire was utilised. The questionnaire covered the five dimensions of trust: perceived competence of the physician, assurance of treatment, confidence in the physician, loyalty towards him/her, and respect for him/her. Items covering four main factors that influence trust, ie shared identity, the physician's behaviour, personal involvement of the physician and level of comfort with him/her, were included in the questionnaire. A structural equation model was constructed with the dimensions of trust on one hand and the four factors influencing trust on the other. Trust in physicians is based more on notional constructs, such as assurance of treatment (b=0.714, ptrust. The former is correlated with the personal involvement of the physician (r=0.124, ptrust in physicians vary with the sociocultural context.

  19. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings.

    Smith, Susan M; Wallace, Emma; O'Dowd, Tom; Fortin, Martin


    Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions to improve outcomes for people with multimorbidity. To determine the effectiveness of health-service or patient-oriented interventions designed to improve outcomes in people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. We searched MEDLINE, EMBASE, CINAHL and seven other databases to 28 September 2015. We also searched grey literature and consulted experts in the field for completed or ongoing studies. Two review authors independently screened and selected studies for inclusion. We considered randomised controlled trials (RCTs), non-randomised clinical trials (NRCTs), controlled before-after studies (CBAs), and interrupted time series analyses (ITS) evaluating interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. This includes studies where participants can have combinations of any condition or have combinations of pre-specified common conditions (comorbidity), for example, hypertension and cardiovascular disease. The comparison was usual care as delivered in that setting. Two review authors independently

  20. Development of a core outcome set for medication review in older patients with multimorbidity and polypharmacy: a study protocol.

    Beuscart, Jean-Baptiste; Dalleur, Olivia; Boland, Benoit; Thevelin, Stefanie; Knol, Wilma; Cullinan, Shane; Schneider, Claudio; O'Mahony, Denis; Rodondi, Nicolas; Spinewine, Anne


    Medication review has been advocated to address the challenge of polypharmacy in older patients, yet there is no consensus on how best to evaluate its efficacy. Heterogeneity of outcomes reported in clinical trials can hinder the comparison of clinical trial findings in systematic reviews. Moreover, the outcomes that matter most to older patients might be under-reported or disregarded altogether. A core outcome set can address this issue as it defines a minimum set of outcomes that should be reported in all clinical trials in any particular field of research. As part of the European Commission-funded project, called OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly, this paper describes the methods used to develop a core outcome set for clinical trials of medication review in older patients with multimorbidity. The study was designed in several steps. First, a systematic review established which outcomes were measured in published and ongoing clinical trials of medication review in older patients. Second, we undertook semistructured interviews with older patients and carers aimed at identifying additional relevant outcomes. Then, a multilanguage European Delphi survey adapted to older patients was designed. The international Delphi survey was conducted with older patients, health care professionals, researchers, and clinical experts in geriatric pharmacotherapy to validate outcomes to be included in the core outcome set. Consensus meetings were conducted to validate the results. We present the method for developing a core outcome set for medication review in older patients with multimorbidity. This study protocol could be used as a basis to develop core outcome sets in other fields of geriatric research.

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

    Kasch, H; Qerama, E; Kongsted, Alice


    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......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...

  2. The role of fear-avoidance cognitions and behaviors in patients with chronic tinnitus.

    Kleinstäuber, Maria; Jasper, Kristine; Schweda, Isabell; Hiller, Wolfgang; Andersson, Gerhard; Weise, Cornelia


    The current study investigated the role of fear-avoidance-a concept from chronic pain research-in chronic tinnitus. A self-report measure the "Tinnitus Fear-Avoidance Cognitions and Behaviors Scale (T-FAS)" was developed and validated. Furthermore, the role of fear-avoidance behavior as mediator of the relationship between anxiety sensitivity and tinnitus handicap was investigated. From a clinical setting, N = 373 patients with chronic tinnitus completed questionnaires assessing tinnitus handicap (Tinnitus Handicap Inventory), anxiety, depression (Hospital Anxiety and Depression Scale), anxiety sensitivity (Anxiety Sensitivity Index-3), personality factors (Big Five Inventory-10), and fear-avoidance. To analyze the psychometric properties, principal component analysis with parallel component extraction and correlational analyses were used. To examine a possible mediating effect, hierarchical regression analysis was applied. The principal component analysis resulted in a three-factor solution: Fear-avoidance Cognitions, Tinnitus-related Fear-Avoidance Behavior, and Ear-related Fear-Avoidance Behavior. Internal consistency was satisfactory for the total scale and all subscales. High correlations between tinnitus-related handicap scales, depressive and anxiety symptoms, and the T-FAS were found, whereas associations with personality factors were low. Moreover, results indicate a significant partial mediation of fear-avoidance behaviors in the relationship between anxiety sensitivity and the cognitive dimension of tinnitus handicap. Results show that fear-avoidance behavior plays an important role in tinnitus handicap. More attention should be paid to this concept in research and clinical practice of psychotherapy for chronic tinnitus.

  3. Proposal for a Candidate Core Set of Fitness and Strength Tests for Patients with Childhood or Adult Idiopathic Inflammatory Myopathies.

    van der Stap, Djamilla K D; Rider, Lisa G; Alexanderson, Helene; Huber, Adam M; Gualano, Bruno; Gordon, Patrick; van der Net, Janjaap; Mathiesen, Pernille; Johnson, Liam G; Ernste, Floranne C; Feldman, Brian M; Houghton, Kristin M; Singh-Grewal, Davinder; Kutzbach, Abraham Garcia; Alemo Munters, Li; Takken, Tim


    Currently there are no evidence-based recommendations regarding fitness and strength tests for patients with childhood or adult idiopathic inflammatory myopathies (IIM). This hinders clinicians and researchers in choosing the appropriate fitness- or muscle strength-related outcome measures for these patients. Through a Delphi survey, we aimed to identify a candidate core set of fitness and strength tests for children and adults with IIM. Fifteen experts participated in a Delphi survey that consisted of 5 stages to achieve a consensus. Using an extensive search of published literature and through the work of experts, a candidate core set based on expert opinion and clinimetrics properties was developed. Members of the International Myositis Assessment and Clinical Studies Group were invited to review this candidate core set during the final stage, which led to a final candidate core set. A core set of fitness- and strength-related outcome measures was identified for children and adults with IIM. For both children and adults, different tests were identified and selected for maximal aerobic fitness, submaximal aerobic fitness, anaerobic fitness, muscle strength tests, and muscle function tests. The core set of fitness- and strength-related outcome measures provided by this expert consensus process will assist practitioners and researchers in deciding which tests to use in patients with IIM. This will improve the uniformity of fitness and strength tests across studies, thereby facilitating the comparison of study results and therapeutic exercise program outcomes among patients with IIM.

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

    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.

  5. Do ICF core sets for low back pain include patients' self-reported activity limitations because of back problems?

    Lygren, Hildegunn; Strand, Liv Inger; Anderson, Bodil; Magnussen, Liv Heide


    The aim of this study was to investigate content validity of the International Classification of Functioning, Disability and Health (ICF) Core Sets for low back pain (LBP), by examining whether common activities reported as difficult to perform are included in the Core Sets. A cross-sectional design was used. Ninety-eight patients with long-lasting back pain (>3 months) between 18 and 65 years of age were consecutively recruited from a Multidisciplinary Outpatient Spine Clinic. Difficulties with daily life and work task activities because of back pain were examined by asking the patients two questions: 1) can you specify activities that are difficult to perform because of your back pain? and 2) are there specific work tasks that you are unable to do because of your back pain? Two raters independently classified the written responses according to the ICF Core Sets' component Activities and Participation. Activities and work tasks were linked to 15 of 29 categories (52%) in the Comprehensive Core Set, and 9 of 12 (75%) in the Brief Core Set, and the initial agreement between the two raters in coding the answers according to the Core Sets was (83%, k = 0.80) and (93%, k = 0.9), respectively, before consensus was reached. The Comprehensive Core Set for LBP to a large degree contains daily life and work-related activities frequently reported as difficult to perform by patients with long-lasting LBP. The categories, however, are very broad and do not provide specified descriptions of the most frequently reported activity limitations such as sitting, standing and walking. The Brief Core Set does not include categories for frequently reported activities such as pulling/pushing and leisure/recreation activities. ICF Core Sets for LBP seem suitable for obtaining a gross overview of the patients' functional limitations, but do not give sufficient information from a therapeutic point of view. © 2013 John Wiley & Sons, Ltd.

  6. Self-Assessed Hearing Handicap in Older Adults with Poorer-than-Predicted Speech Recognition in Noise

    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)…

  7. Self-Assessed Hearing Handicap in Older Adults with Poorer-than-Predicted Speech Recognition in Noise

    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)…




  9. Improving patient health engagement with mobile texting: A pilot study in the head and neck postoperative setting.

    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.

  10. Patient and dental student responses to a survey about AIDS in the dental setting.

    Thaker, H J; Gobetti, J P; Green, T G


    The purpose of the study was to gain information about patients' and dental students' attitudes concerning AIDS and dentistry. Opinions of patients and students at a Midwestern dental school were surveyed. The dental students' responses were not as consistent as the patient responses. Both groups felt there was a risk to patients and dentists of HIV infection. Both groups had confidence in the CDC infection control guidelines. The patient responses to the testing questions were significantly more positive than the student responses. The patients responded positively to the concept that healthcare professionals had the right to ask patients to be tested and to being required to be tested if a healthcare provider is accidentally stuck by a needle used on a patient. The dental students were more cautious with both issues. Patients would use knowledge about a healthcare provider's HIV status and the office treatment of AIDS patients to determine if they should continue treatment at that dental office.

  11. The occurrence and perceived influence of nurses on patient problems across nursing settings.

    Kieft, R.A.M.M.; Francke, A.L.; Delnoij, D.M.J.


    Background: In order to enhance the nursing profession and its scientific foundation, nurses need to demonstrate how they contribute to quality of care and good outcomes in their patients. This requires systematic, standardized data collection about patient problems, nursing interventions and patient outcomes. However, currently little is known about which patient problems nurses encounter in daily practice, how they help their patients in dealing with these problems, and with which result. A...

  12. The ethical leadership challenge: creating a culture of patient- and family-centered care in the hospital setting.

    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.

  13. Expression of SET Protein in the Ovaries of Patients with Polycystic Ovary Syndrome

    Xu Boqun


    Full Text Available 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<0.05. Conclusion. SET was overexpressed in 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.

  14. The applicability of the dysphonia severity index and the voice handicap index in evaluating effects of voice therapy and phonosurgery.

    Hakkesteegt, Marieke M; Brocaar, Michael P; Wieringa, Marjan H


    The objective was to investigate the applicability of the Dysphonia Severity Index (DSI) and the Voice Handicap Index (VHI) in evaluating effects of intervention between groups of patients and for intrasubject differences and whether DSI and VHI are complementing measurements. Analyses of measurement data before and after intervention of 171 patients with voice disorders. The voice quality was measured objectively with the DSI. The perceived voice handicap was measured with the VHI. Three groups of patients were used: patients who had voice therapy, phonosurgery, or no intervention. DSI and VHI improved significantly after intervention in the voice therapy and the surgery group (median difference DSI 1.19 and 3.03, VHI -8 and -26, respectively). The intrasubject results were analyzed based on the test-retest variability of DSI and VHI. Significant better DSI and VHI scores after intervention were found in, respectively, 22% and 38% of the patients with voice therapy, and 56% and 78% of the patients with surgery. In the no intervention group, this was 11% and 12%. In 37% of the patients, the differences before and after intervention in DSI and VHI were in discordance. The DSI and VHI are able to show significant differences after intervention for voice disorders between groups of patients. The DSI and VHI can be used to determine a significant intrasubject result of intervention. The DSI and VHI measure each different aspects of the voice and are complementing measurements. The DSI is therefore applicable in clinical practice for objective evaluation of voice quality and the VHI for subjective evaluation of the perceived handicap by the patient self.

  15. Clinical utility of a standardized electronic order set for the management of acute upper gastrointestinal hemorrhage in patients with cirrhosis.

    Mayorga, Christian A; Rockey, Don C


    Recent reductions in mortality after acute upper gastrointestinal hemorrhage among patients with cirrhosis have been attributed to early and aggressive use of guideline-recommended pharmacologic agents, antibiotics, and endoscopic therapy. Studies have shown, however, that adherence to recommended guidelines is low. We investigated whether use of a standardized electronic order set would improve adherence to treatment and timeliness of delivery. We performed a prospective observational study, implementing an electronic order set for 123 patients with known or suspected cirrhosis who presented with symptoms/signs of upper gastrointestinal hemorrhage at Parkland Memorial Hospital (in Dallas, TX) from July 2011 through June 2012. The order set included standard nursing orders, laboratory tests, medications, orders for consultative services, and a brief evidence-based review of the benefits of octreotide and antibiotics in patients with cirrhosis. Primary outcomes included overall adherence to the administration of octreotide and antibiotics and the performance of upper endoscopy, as well as time to these interventions. Administration of antibiotics increased in patients for whom the order set was used (100% vs 89% for whom it was not used; P = .01); the use of the order set significantly reduced the time to administration of antibiotics (3 h 28 min vs 10 h 4 min; P upper gastrointestinal hemorrhage. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

  16. Valuing psychiatric patients' stories: belief in and use of the supernatural in the Jamaican psychiatric setting.

    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.

  17. Questionário Hearing Handicap Inventory for the Elderly - Screening version (HHIE-S: estudo da sensibilidade e especificidade Questionnaire Hearing Handicap Inventory for the Elderly - Screening version (HHIE-S: sensitivity and specificity study

    Ana Carolina Argondizo de Rosis


    complaints regarding their hearing, and 55 attended at the Audiology Clinic of the same institution with complaints related to the auditory and/or vestibular systems - was assessed. The HHIE-S questionnaire was applied, and its total score was divided into three categories, according to the handicap perception. RESULTS: A statistically significant relationship was found between handicap and degree of hearing loss in both patients from the Audiology Clinic (p=0.009* and from the Geriatrics Clinic (p=0.002. In the first group, the HHIE-S questionnaire showed low sensitivity (23.5% and high specificity (73.7%. In the group of patients from the Geriatrics Clinic, the values of sensitivity (94.7% and specificity (75% were both high. CONCLUSIONS: There was positive association between the degree of hearing loss and the handicap referred by both groups of subjects. The HHIE-S questionnaire is a hearing screening instrument with high sensitivity and specificity in identifying hearing loss in elderly people that seek health care services that are not specific for attention related to hearing disorders.

  18. Is Being Gifted a Social Handicap?

    Coleman, Laurence J.; Cross, Tracy L.


    The paper explores the question of how gifted and talented adolescents experience being gifted in high school. Fifteen subjects were interviewed twice while attending a special summer program in order to answer this general question. The data were analyzed and interpreted using a set of research questions which postulated that the subjects would…

  19. An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings

    Irisawa, Taro; Iwami, Taku; Kitamura, Tetsuhisa; Nishiyama, Chika; Sakai, Tomohiko; Tanigawa-Sugihara, Kayo; Hayashida, Sumito; Nishiuchi, Tatsuya; Shiozaki, Tadahiko; Tasaki, Osamu; Kawamura, Takashi; Hiraide, Atsushi; Shimazu, Takeshi


    Background: Stroke is difficult to diagnose when consciousness is disturbed. However few reports have discussed the clinical predictors of stroke in out-of-hospital emergency settings. This study aims to evaluate the association between initial systolic blood pressure (SBP) value measured by emergency medical service (EMS) and diagnosis of stroke among impaired consciousness patients. Methods: We included all patients aged 18 years or older who were treated and transported by EMS, and had imp...

  20. Quality of Care in the Psychiatric Setting : Perspectives of the Patient, Next of Kin and Care staff

    Schröder, Agneta


    The overall aim of this thesis was to describe quality of care from different perspectives in the psychiatric setting, to develop an instrument for measuring quality of care from the in-patient perspective and to use this instrument empirically. A qualitative descriptive design involving a phenomenographic analysis was used in Studies I, III and IV, and a descriptive and comparative design with statistical analysis in Study II. In Study I, 20 patients were interviewed. The results showed that...

  1. Patient-Rated Alliance as a Measure of Therapist Performance in Two Clinical Settings

    Imel, Zac E.; Hubbard, Rebecca A.; Rutter, Carolyn M.; Simon, Gregory


    Objective: The ability to form a strong therapeutic alliance is considered a foundational skill across psychotherapies. Patient-rated measures of the alliance are now being used to make judgments about a therapist's tendency to build alliances with their patients. However, whether a patient-rated alliance measure provides a useful index of a…

  2. Doctor-Patient Communication in a Southeast Asian Setting: The Conflict between Ideal and Reality

    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…

  3. Doctor-patient communication in a Southeast Asian setting: the conflict between ideal and reality.

    Claramita, M.; Utarini, A.; Soebono, H.; Dalen, J. Van; Vleuten, C.P.M. van der


    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 cont

  4. Doctor-Patient Communication in a Southeast Asian Setting: The Conflict between Ideal and Reality

    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…

  5. Finger prosthesis: a boon to handicapped.

    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.

  6. [Comparability and conversion of Stimmstörungsindex (SSI) and Voice Handicap Index (VHI)].

    Gugatschka, M; Rechenmacher, J; Chibidziura, J; Friedrich, G


    The Voice Handicap Index (VHI) has been established internationally as a reliable tool for describing voice-dependent quality of life. Nawka developed a new score by using 12 questions out of the VHI, called SSI (Stimmstörungsindex) . The SSI has proven its role in daily clinical routine, main problem remains a lack of comparability of the SSI (range: 0 - 48) to the internationally established VHI (Voice Handicap Index) (range: 0 - 120). Aim of our study was to demonstrate that by a simple multiplication of SSI scores a statistically significant correlation with scores of the VHI can be achieved. 210 consecutive patients of the ENT University Hospital Graz were evaluated by the German version of VHI. We calculated total score of VHI as well as the score of the SSI. By multiplication of the SSI scores by 2.5 we calculated a new score, called "VHI-korr". This score was compared with the VHI. We can demonstrate that by simple multiplication of the SSI scores by 2.5 a statistically significant correlation to the VHI can be achieved (r = 0.98; p SSI- based "VHI-korr" provides good international comparability of voice disorders with VHI and allows to maintain the common use of SSI in daily clinical routine.

  7. Development of a core outcome set for medication review in older patients with multimorbidity and polypharmacy: a study protocol

    Beuscart JB


    Full Text Available Jean-Baptiste Beuscart,1 Olivia Dalleur,1 Benoit Boland,2 Stefanie Thevelin,1 Wilma Knol,3 Shane Cullinan,4 Claudio Schneider,5 Denis O’Mahony,6 Nicolas Rodondi,4,7 Anne Spinewine1,8 1Université catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, Brussels, Belgium; 2Geriatric Medicine, Cliniques universitaires Saint-Luc, Brussels, Université catholique de Louvain, Belgium; 3Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR, University Medical Centre Utrecht, Netherlands; 4School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland; 5Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland; 6Department of Medicine (Geriatrics, University College Cork, Cork, Ireland; 7Institute of Primary Health Care (BIHAM, University of Bern, Bern, Switzerland; 8Université catholique de Louvain, CHU UCL Namur, Pharmacy Department, Yvoir, Belgium Background: Medication review has been advocated to address the challenge of polypharmacy in older patients, yet there is no consensus on how best to evaluate its efficacy. Heterogeneity of outcomes reported in clinical trials can hinder the comparison of clinical trial findings in systematic reviews. Moreover, the outcomes that matter most to older patients might be under-reported or disregarded altogether. A core outcome set can address this issue as it defines a minimum set of outcomes that should be reported in all clinical trials in any particular field of research. As part of the European Commission-funded project, called OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly, this paper describes the methods used to develop a core outcome set for clinical trials of medication review in older patients with multimorbidity. Methods/design: The study was designed in several steps. First, a systematic review established which outcomes were measured in published

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

    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

  9. Evaluating the influence of perceived pain control on patient satisfaction in a hospital setting.

    Craig, Angela R; Otani, Koichiro; Herrmann, Patrick A


    The authors evaluated whether a patient's perceived pain control influenced the relationships between four attributes (nursing, physician, staff, and environment) and patient satisfaction. Multiple linear regression analyses were conducted to examine overall satisfaction and intention to recommend, controlling for race, gender, age, and education. The authors found that no matter the level of pain control, nursing was always the most influential attribute in patient satisfaction. The influence of the other attributes varied, depending on the patients' pain control. Hospital managers may improve patient satisfaction by focusing on pain management nursing care.

  10. Selecting an optimal abbreviated ICF set for clinical practice among rehabilitants with subacute stroke: retrospective analysis of patient records.

    Saltychev, Mikhail; Tarvonen-Schröder, Sinikka; Eskola, Merja; Laimi, Katri


    To evaluate the adequacy of abbreviated versions of International Classification of Functioning, Disability and Health (ICF) (the WHO ICF Checklist and the ICF Comprehensive Core Set for Stroke) with respect to the specific clinical needs of a stroke rehabilitation unit before their implementation at a practical level. Common descriptions of functional limitations were identified from patient records of 10 subsequent subacute stroke patients referred to an inpatient multiprofessional rehabilitation unit of a university hospital. These descriptions were then converted into ICF categories, and the list was compared with the ICF Checklist of the WHO and the ICF Comprehensive and Brief Core Sets for Stroke developed by the ICF Research Branch. From the study population (50% women), 71 different, second-level ICF categories were identified, averaging 36.4 categories/patient (SD 5.8, range 28-46). Except for one category, all of the categories identified were also found in the ICF Comprehensive Core Set for Stroke. Of the categories identified, 49 (69%) were found in the WHO ICF Checklist. All except one category included in the ICF Brief Core Set for Stroke were also in our list. The Comprehensive Core Set for Stroke was found to be a good potential starting point for the practical implementation of the ICF in a stroke rehabilitation unit.

  11. Voice-controlled Internet Browsing for Motor-handicapped Users

    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...

  12. Dental caries and periodontal status of mentally handicapped institutilized children.

    Solanki, Jitender; Gupta, Sarika; Arya, Astha


    Dental caries and periodontal disease are the most prevalent dental disease among mentally retarded children worldwide. A study was carried out in Jodhpur city of Rajasthan state of India to assess the Dental caries and periodontal Status of Mentally handicapped attending special schools children in Jodhpur city. A cross-sectional descriptive survey was conducted in 80 mentally handicapped subjects, attending a Special Needs school in Jodhpur City. Dental caries and Periodontal Status were recorded following the WHO basic oral health survey. None of the subject had healthy periodontal status, dental caries was found in 79.2% of the subjects, Lymphadenopathy was observed in highest number of subjects 55 (76.3%). Health professionals should therefore be aware of the impact of mental illness and its treatment on oral health, Health personnel should receive training to support and provide all possible services to this population.

  13. 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

    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)

  14. Validity and Reliability of the Persian Version of the Dysphagia Handicap Index (DHI

    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.

  15. Retrospective analysis of patients with carcinoma cervix in a rural/semi-urban setting in Western India

    Ranvijay Singh


    Full Text Available Objectives: To compare the presentation of cervical cancer and the treatment modalities received by the patients at a semi-urban/rural area of Western India with that of published literature from urban centers. Materials and Methods: We conducted a retrospective analysis of patients with cervical cancer who presented at a semi-urban/rural cancer center between 2010 and 2013. A total of 141 patients with the median age of 51 years (25-81 were studied. The demographic and clinical variables included age, annual family income, profession, comorbidities, baseline hemoglobin, prior screening, clinical stage, treatment administered, and complications. The pathological variables included tumor type and grade. Results: In our study, all patients presented with vaginal bleeding. Majority of the patients (51 patients, 37.7% had Stage 3B disease. Since majority presented at later stages (Stage 3B, chemotherapy-radiotherapy was the most common treatment modality used in our population. On histopathology, 127 patients (90% had squamous cell carcinoma while 14 patients (10% had adenocarcinoma. In 96 patients (68%, the tumor grade was not known while it was a high, intermediate, and low grade in 6 (4%, 18 (13%, and 21 (15% patients, respectively. The follow-up data of our study were not adequate; hence, the long-term survival results could not be presented. Conclusion: Patients in rural India setting present at later stages which could be improved by creating awareness, improving their personal hygiene, and adequate screening.

  16. ICF Core Set for Head and Neck Cancer: Do the Categories Discriminate Among Clinically Relevant Subgroups of Patients?

    Tschiesner, Uta; Oberhauser, Cornelia; Cieza, Alarcos


    The multidisciplinary assessment of functioning in patients with head and neck cancer (HNC) according to the "ICF Core Set for Head and Neck Cancer" (ICF-HNC) was developed in an international and multi-disciplinary approach. The ICF-HNC is an application of the ICF that was adopted by the World Health Organization. The objective of this study was…

  17. Exploring the Relationships between the Electronic Health Record System Components and Patient Outcomes in an Acute Hospital Setting

    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…

  18. Determinants of patient satisfaction: a study among 39 hospitals in an in-patient setting in Germany.

    Schoenfelder, Tonio; Klewer, Joerg; Kugler, Joachim


    To identify key determinants of patient satisfaction. Data used were obtained through a self-administered, post-visit questionnaire by random sampling during the period of January 2009 to September 2009. Thirty-nine hospitals in Germany. A total of 8,428 patients. Global patient satisfaction was measured by a single item question. Attributes of medical aspects of care were measured using 12 items, performance of service using 3 items and different dimensions of patient expectations using 12 items. Medical aspects of care and performance of service items were entered into logistic regression analysis to identify determinants of patient satisfaction. The results of the analysis showed that there are 10 determinants of global patient satisfaction. The outcome of treatment was overall, the most salient predictor followed by nursing kindness as the second most important component. Items reflecting information receiving about the undergoing treatment do not have a major influence on patient satisfaction. The analysis identified key determinants that should be altered first in order to improve global patient satisfaction. The results also indicate that some aspects of the hospital stay are not seen as relevant by patients and therefore are unrelated to satisfaction ratings. The findings suggest that variables measuring patients' perceptions of care are more important determinants of global patient satisfaction in comparison to demographics and visit characteristics. Results of the present study have implications for health providers aiming at improving the service quality and quality of care.

  19. How patients understand physicians' solicitations of additional concerns: implications for up-front agenda setting in primary care.

    Robinson, Jeffrey D; Heritage, John


    In the more than 1 billion primary-care visits each year in the United States, the majority of patients bring more than one distinct concern, yet many leave with "unmet" concerns (i.e., ones not addressed during visits). Unmet concerns have potentially negative consequences for patients' health, and may pose utilization-based financial burdens to health care systems if patients return to deal with such concerns. One solution to the problem of unmet concerns is the communication skill known as up-front agenda setting, where physicians (after soliciting patients' chief concerns) continue to solicit patients' concerns to "exhaustion" with questions such as "Are there some other issues you'd like to address?" Although this skill is trainable and efficacious, it is not yet a panacea. This article uses conversation analysis to demonstrate that patients understand up-front agenda-setting questions in ways that hamper their effectiveness. Specifically, we demonstrate that up-front agenda-setting questions are understood as making relevant "new problems" (i.e., concerns that are either totally new or "new since last visit," and in need of diagnosis), and consequently bias answers away from "non-new problems" (i.e., issues related to previously diagnosed concerns, including much of chronic care). Suggestions are made for why this might be so, and for improving up-front agenda setting. Data are 144 videotapes of community-based, acute, primary-care, outpatient visits collected in the United States between adult patients and 20 family-practice physicians.

  20. The handicap process favors exaggerated, rather than reduced, sexual ornaments.

    Tazzyman, Samuel J; Iwasa, Yoh; Pomiankowski, Andrew


    Why are traits that function as secondary sexual ornaments generally exaggerated in size compared to the naturally selected optimum, and not reduced? Because they deviate from the naturally selected optimum, traits that are reduced in size will handicap their bearer, and could thus provide an honest signal of quality to a potential mate. Thus if secondary sexual ornaments evolve via the handicap process, current theory suggests that reduced ornamentation should be as frequent as exaggerated ornamentation, but this is not the case. To try to explain this discrepancy, we analyze a simple model of the handicap process. Our analysis shows that asymmetries in costs of preference or ornament with regard to exaggeration and reduction cannot fully explain the imbalance. Rather, the bias toward exaggeration can be best explained if either the signaling efficacy or the condition dependence of a trait increases with size. Under these circumstances, evolution always leads to more extreme exaggeration than reduction: although the two should occur just as frequently, exaggerated secondary sexual ornaments are likely to be further removed from the naturally selected optimum than reduced ornaments.

  1. Recreational drug use and fluctuating asymmetry: testing the handicap principle.

    Borkowska, Barbara; Pawlowski, Boguslaw


    Zahavi's handicap principle suggests that only organisms with good genetic quality can afford to engage in costly behaviors. Recreational drug use can be harmful to one's health and therefore might be viewed as a costly signal of one's genetic quality. One of the measurements of genetic quality is bodily symmetry assessed by fluctuating asymmetry. If unhealthy drug use is a behavioral example of Zahavi's handicap principle, then men who use different stimulants or recreational drugs should be more symmetrical than men who do not use them at all or use them only in low quantity. The aim of this study was to examine the relationships between drug use and fluctuating asymmetry. The subjects were 190 young women and 202 young men. Six bilaterally symmetrical traits were measured: length of II-V digits, wrist breadth, and ear height. Questionnaires included questions about smoking, alcohol drinking, drug use, and designer drug use. There was no relationship between bodily symmetry and smoking frequency, alcohol drinking frequency, drug or designer drug use, total substance use, age of smoking initiation, or reason of this initiation. The results indicate that drug use does not reflect genetic quality and does not necessarily relate to the handicap hypothesis.

  2. Subjective Voice Assessment after Endoscopic Surgery for an Obstructive Reinke Edema Using Voice Handicap Index

    Bassel Hallak


    Full Text Available Voice disorders exert a dramatic influence on patients’ quality of life (QOL. The physical, functional, and emotional impact can be accurately assessed using the conventional questionnaire of “voice handicap index” (VHI or its shorter version, the VHI-10. We evaluated the VHI scores of patients suffering from obstructive Reinke’s edema, a benign laryngeal disorder, before and after endoscopic treatment. Comparison of pre- and postoperative VHI scores showed the treatment efficacy. The scores achieved were similar to asymptomatic individuals (control group, thus improving their quality of life. Furthermore, both VHI and VHI-10 tests yielded similar scores. We suggest routine systematic incorporation of the VHI-10 test for pre- and postoperative routine evaluation of patients with Reinke’s edema. The results are faster and reliable.

  3. Voice and speech range profiles and Voice Handicap Index for males--methodological issues and data.

    Hallin, Anna Eva; Fröst, Karin; Holmberg, Eva B; Södersten, Maria


    Reference data for speech range profiles (SRP), voice range profiles (VRP), and Voice Handicap Index (VHI) are presented for Swedish males (n = 30). For comparisons, individual data for four male contact granuloma patients are also reported. For the vocally healthy group mean values were: speaking fundamental frequency 123 Hz (SD 12.1), speaking equivalent level, Leq, 72.2 dB (SD 2.1), SRP area 142 ST*dB (SD 24.1), and VRP area 1,706 ST*dB (SD 340). Mean VHI was 5 (SD 4.8). Test-retest recordings of VRP and SRP for three subjects suggested good reliability. SRP and VRP values for three of the patients fell more than 2 SD outside the reference values. Protocols and results are discussed and standardized recording and analyses procedures are suggested.

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

    Maha Mohamed Ghobashi; Hanan Abdel Ghani El-ragehy; Hanan Mosleh Ibrahim; Fatma Abdullah Al-Doseri


    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 resp...

  5. Addressing Barriers to Shared Decision Making Among Latino LGBTQ Patients and Healthcare Providers in Clinical Settings.

    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.

  6. Outpatient costs in pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting

    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.

  7. [Excess mortality of severely handicapped patients in mandatory health insurance].

    Piechowiak, H; Greschniok, P; Knorr, U


    The introduction of compulsory long term care insurance as of 1.1. 1995 has temporarily brought to an end a whole range of controversial discussions, which have been strongly coloured by party political interests. The originally planned expenditure figure of at least DM 30 billion represents an enormous outlay in these time of economic recession. It is already abundantly clear that the premium payments will not be sufficient in the long run, nor will it be possible to increase these premiums arbitrarily. This therefore elicits the question as to whether it is possible to calculate in advance the cost of treatment for those "in serious need of nursing care" on the basis of various factors such as age, sex, underlying illness, therapy and social integration. Up to now, there has been very little statistical analysis of these parameters. For this reason, the company MDK has carried out a preliminary survey (which so far has only looked at a limited number of cases) in order to obtain a general idea of the variations in the period required for long term care. This survey has shown that there are two main groups of cases requiring care, which can be differently assessed on the basis of age and sex. On the one hand, there are those in serious need of nursing care, who, due to a life-threatening disease or as a result of an acute deterioration of an existing chronic condition (e.g. severe KHK, cirrhosis of the liver, decompensated renal insufficiency) die a relatively short time after the application for care is made.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Effectiveness of sound therapy in patients with tinnitus resistant to previous treatments: importance of adjustments

    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.

  9. HER2-Positive Metastatic Breast Cancer Patients Receiving Pertuzumab in a Community Oncology Practice Setting: Treatment Patterns and Outcomes.

    Robert, Nicholas J; Goertz, Hans-Peter; Chopra, Pooja; Jiao, Xiaolong; Yoo, Bongin; Patt, Debra; Antao, Vincent


    Pertuzumab (Perjeta(®)), a HER2/neu receptor antagonist, was approved by the US Food and Drug Administration in June 2012 for use in the first-line setting for patients with HER2-positive metastatic breast cancer (mBC). This retrospective study investigated the clinical and demographic characteristics, treatment patterns, safety, and clinical outcomes for patients with HER2-positive mBC who received pertuzumab in the first-line setting in US community oncology practices. Patients with HER2-positive mBC, who initiated pertuzumab within 60 days of mBC diagnosis between June 2012 and June 2014, followed through December 2014, had ≥2 visits within the McKesson Specialty Health/US Oncology Network, and were not on clinical trials during the study period, were eligible. This study utilized iKnowMed electronic health records, Claims Data Warehouse, and Social Security Death Index. Progression-free survival (PFS) was assessed by Kaplan-Meier methods. A total of 266 patients met the selection criteria. A vast majority of the patients (249/266, 93.6%) received a trastuzumab + pertuzumab + taxane (H + P + T) regimen. The number of patients with prior adjuvant/neoadjuvant therapy was higher than the CLEOPATRA trial, but age (median 57 years) and percentage of visceral disease (74.8%) were similar. The most common adverse events were fatigue (50.8%), diarrhea (44.7%), nausea (35.3%), peripheral neuropathy (33.5%), neutropenia (24.9%), and rash (24.4%). The median PFS was 16.9 months (95% CI 14.2-19.7). In this retrospective study of patients with HER2-positive mBC receiving pertuzumab in the first-line setting, most patients were treated with H + P + T. The safety and PFS of H + P + T were consistent with those observed in the pivotal trial.

  10. Implementation and adoption of mechanical patient lift equipment in the hospital setting: The importance of organizational and cultural factors.

    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.

  11. Variables Affecting Patient Satisfaction with Health Care Services in the College Health Setting.

    Gillette, Joyce L.; And Others


    Five hundred college students who had used Kent State University's School Health Service were surveyed to determine patient satisfaction with health care services. Overall satisfaction with the services was high, and satisfaction was significantly influenced by patients' perceptions of practitioners' technical competence and by the adequacy of the…

  12. Follow-up of patients with rheumatic heart diseases in the outpatient setting

    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.

  13. Patient experience and use of probiotics in community-based health care settings

    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

  14. Analysis of gene expression using gene sets discriminates cancer patients with and without late radiation toxicity

    J.P. Svensson; L.J.A. Stalpers; R.E.E. Esveldt-van Lange; N.A.P. Franken; J. Haveman; B. Klein; I. Turesson; H. Vrieling; M. Giphart-Gassler


    Background Radiation is an effective anti-cancer therapy but leads to severe late radiation toxicity in 5%-10% of patients. Assuming that genetic susceptibility impacts this risk, we hypothesized that the cellular response of normal tissue to X-rays could discriminate patients with and without late

  15. A Comprehensive Approach to Identifying Intervention Targets for Patient-Safety Improvement in a Hospital Setting

    Cunningham, Thomas R.; Geller, E. Scott


    Despite differences in approaches to organizational problem solving, healthcare managers and organizational behavior management (OBM) practitioners share a number of practices, and connecting healthcare management with OBM may lead to improvements in patient safety. A broad needs-assessment methodology was applied to identify patient-safety…

  16. The patient experience of remote telemonitoring for heart failure in the rural setting: a literature review.

    Jones, Lauren; Grech, Carol


    Remote telemonitoring is utilised to provide specialised care to people with heart failure living in rural locations. There is limited research into the patients' experience of telemonitoring. This literature review was completed to examine the available evidence and inform the development of a telemonitoring service. Cochrane Database of Systematic Reviews; Medline; CINAHL database, Joanna Briggs Institute, AMED, EMBASE were searched using the key words. A thematic analysis was applied. Forty-six studies reviewed, 11 met inclusion criteria. Individual health status, use of technology, and effect on lifestyle influenced the patient experience. Limited literature was available addressing the patient experience of telemonitoring and no studies were found that specifically investigated the experiences of patients with heart failure in rural locations. Further research is required to examine the patient/user perspective of this type of service, and explore the feasibility of including telemonitoring in usual care.

  17. Life goes on - Priority settings in patients with cancer and comorbidities

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

    . Method General practitioners in Region Zealand have included eligible patients, who have one or more chronic diseases, and who have recently finished primary treatment for a non-metastatic cancer. Thirteen patients have been included in the study. Semi-structured interviews have been carried out......Background As the number of patients living with cancer is increasing, a growing population of cancer patients will also deal with comorbid chronic diseases. The period after completed cancer treatment can be a vulnerable time including uncertainty about health status, physical and emotional...... symptoms from cancer disease and treatment. This might influence patients’ priorities and attention to comorbidities. Some studies show that the quality of care for the comorbid chronic diseases and participation in regular follow-up consultations are lower among patients with a cancer diagnosis compared...

  18. Has beta-blocker use increased in patients with heart failure in internal medicine settings? Prognostic implications: RICA registry.

    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.

  19. Focus Groups in Elderly Ophthalmologic Patients: Setting the Stage for Quantitative Preference Elicitation.

    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.

  20. Patients' Perceptions of Dehumanization of Patients in Dental School Settings: Implications for Clinic Management and Curriculum Planning.

    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.

  1. Describing clinical faculty experiences with patient safety and quality care in acute care settings: A mixed methods study.

    Roney, Linda; Sumpio, Catherine; Beauvais, Audrey M; O'Shea, Eileen R


    A major safety initiative in acute care settings across the United States has been to transform hospitals into High Reliability Organizations. The initiative requires developing cognitive awareness, best practices, and infrastructure so that all healthcare providers including clinical faculty are accountable to deliver quality and safe care. To describe the experience of baccalaureate clinical nursing faculty concerning safety and near miss events, in acute care hospital settings. A mixed method approach was used to conduct the pilot study. Nurse faculty (n=18) completed study surveys from the Agency for Healthcare Research and Quality (AHRQ) to track patient safety concerns: Incidents; Near misses; or Unsafe conditions, during one academic semester, within 9 different acute care hospitals. Additionally, seven nurse faculty participated in end of the semester focus groups to discuss the semester long experience. Clinical faculty identified a total of 24 patient occurrences: 15 Incidents, 1 Near miss event, and 8 Unsafe conditions. Focus group participants (n=7) described benefits and challenges experienced by nursing clinical faculty and students in relation to the culture of safety in acute care hospital settings. Six themes resulted from the content analysis. Utilizing nursing clinical faculty and students may add significant value to promoting patient safety and the delivery of quality care, within acute care hospital settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Patients receiving opioid maintenance treatment in primary care: successful chronic hepatitis C care in a real world setting

    Seidenberg André


    Full Text Available Abstract Background Injection drug users (IDUs represent a significant proportion of patients with chronic hepatitis C (CHC. The low treatment uptake among these patients results in a low treatment effectiveness and a limited public health impact. We hypothesised that a general practitioner (GP providing an opioid maintenance treatment (OMT for addicted patients can achieve CHC treatment and sustained virological response rates (SVR comparable to patients without drug dependency. Methods Retrospective patient record analysis of 85 CHC patients who received OMT for more than 3 months in a single-handed general practice in Zurich from January 1, 2002 through May 31, 2008. CHC treatment was based on a combination with pegylated interferon and ribavirin. Treatment uptake and SVR (undetectable HCV RNA 6 months after end of treatment were assessed. The association between treatment uptake and patient characteristics was investigated by multiple logistic regression. Results In 35 out of 85 CHC patients (52 males with a median (IQR age of 38.8 (35.0-44.4 years, antiviral therapy was started (41.2%. Median duration (IQR of OMT in the treatment group was 55.0 (35.0-110.1 months compared to the group without therapy 24.0 (9.8-46.3 months (p Conclusion In addicted patients a high CHC treatment and viral eradication rate in a primary care setting in Switzerland is feasible. Opioid substitution seems a beneficial framework for CHC care in this “difficult to treat” population.

  3. Insulin pump patient characteristics and glucose control in the hospitalized setting.

    Kannan, Subramanian; Satra, Ankita; Calogeras, Ellen; Lock, Patricia; Lansang, M Cecilia


    Patients' knowledge of their insulin pumps and glucose control during hospitalization has not been studied. The aim was to study the determinants of glycemic control in patients using continuous subcutaneous insulin infusion (CSII) in the hospital. Three groups of patients were identified: those who did not need any inpatient education and continued on CSII (gorup A), those who received education then continued on CSII (group B), and those for whom CSII was not appropriate and were treated with multiple daily insulin injections (gorup C). We compared the measures of glycemic control between the 3 groups and analyzed which variables impacted glucose control. There were 50 patients, with 51 hospital admissions, 57% males, mean age 48 ± 13 years, 86% had type 1 diabetes (T1DM). The mean DM duration was 26 ± 14 years, mean duration of CSII use was 8.7 ± 6 years, and mean HbA1c was 7.6 ± 1.4%. The mean duration of hospital stay was 5.6 ± 4.6 days. Mean blood glucose (BG) and frequency of hyperglycemia and hypoglycemic events among the 3 groups adjusted for their duration of hospital stay were not statistically different. None of the patients developed diabetic ketoacidosis while using their pump. Stepwise multivariate analysis revealed knowledge of hypoglycemia correction was the single most important predictor of mean BG (P < .001). Patients who received inpatient education performed similarly to patients who did not need inpatient education. Patients who receive inpatient education on CSII fare similar as patients who did not require inpatient education. © 2014 Diabetes Technology Society.

  4. Patient and organisational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis.

    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 variables entered the explanatory model, indicates that the HAPU problem may be reduced by ward-level 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

  5. Cutaneous adverse drug reaction profile in a tertiary care out patient setting in Eastern India

    Abanti Saha


    Conclusions: Cutaneous adverse drug reaction profile in this study is similar in many ways to studies conducted earlier in India. Incidence of life-threatening reactions like SJS-TEN was higher compared with studies conducted abroad. Reaction time and lesion patterns are helpful in identifying an offending drug in the setting of multiple drug therapy.

  6. Pattern of postoperative pain management among adult surgical patients in a low-resource setting

    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

  7. Japanese version of voice handicap index for subjective evaluation of voice disorder.

    Taguchi, Aki; Mise, Kazuyo; Nishikubo, Kaori; Hyodo, Masamitsu; Shiromoto, Osamu


    Recently, the Voice Handicap Index (VHI), developed in the United States, has been highlighted as a means to assess a patient's perceptions of the severity of his or her voice disorder. The VHI is based on a self-administered questionnaire that quantifies the degree of a patient's disability related to his/her voice disorder. The questionnaire was translated into Japanese and applied to Japanese patients with various kinds of disordered voice or dysphonia. The results were analyzed and the usefulness discussed. In this study, 546 patients (281 males and 265 females) were included. Mean VHI scores were 36.2/120 in males and 44.1/120 in females. In the male patients, VHI scores were the highest among teens. However, VHI scores did not vary with age in the female patients. Patients with vocal fold paralysis, functional dysphonia, psychological dysphonia, and spasmodic dysphonia showed relatively high VHI scores, whereas those with laryngeal granuloma and laryngopharyngeal reflux disease showed low scores. In most diseases, functional and physiological scores were higher than emotional scores. In any treated patients, those with vocal nodule, vocal polyp, polypoid vocal fold, and recurrent laryngeal nerve paralysis, VHI scores decreased after therapeutic intervention. These findings suggest that the Japanese VHI is a useful tool for monitoring a patient's psychological status, choosing appropriate treatment, and assessing the therapeutic outcome.

  8. Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine.

    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 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. Development of a Rheumatology-specific Patient Concerns Inventory and Its Use in the Rheumatology Outpatient Clinic Setting.

    Ahmed, Ashar E; Lowe, Derek; Kirton, Jennifer A; O'Brien, Mary R; Mediana, Ayren; Frankland, Helen; Bruce, Hannah; Kennedy, Tom; Rogers, Simon N; Moots, Robert J


    Successful management of rheumatic conditions involves increasing complexity of care. Delivering this in a holistic way is a growing challenge. The aim of our study was to develop a Patient Concerns Inventory (PCI) and assess it in the rheumatology clinic setting. This observational exploratory study occurred with 2 phases. In phase I, the PCI was developed after a systematic literature search, expert opinion, and 3 patient focus group discussions. In phase II, the PCI was piloted in a general rheumatology clinic. Fifty-four patients were assessed in the pre-PCI group and 51 in the post-PCI group. Median (IQR) duration of consultation was 8 min (5-14) without PCI and 15 min (10-20) with PCI. The pre-PCI group raised 335 concerns from 50 patients, median (IQR) of 5 (3-10) per patient, rising post-PCI to 521 concerns, median (IQR) of 9 (5-16) from 51 patients, p = 0.002. Additional concerns predominantly arose from "physical and functional well-being" and "social care and well-being" domains. Most patients rated their experience with their doctor in the consultation as excellent or outstanding across all 11 questions in the questionnaire, both before and after the introduction of the PCI to the clinic setting. The PCI is a useful holistic needs assessment tool for rheumatology clinics. Although its use may initially prolong the consultation slightly, patients can raise a significantly higher number of concerns, which does not occur at the expense of patient satisfaction. This may help in identifying areas of unmet needs that previously went unnoticed.

  10. Access to medications in the community by patients in a palliative setting. A systems analysis.

    Lucey, M; McQuillan, R; MacCallion, A; Corrigan, M; Flynn, J; Connaire, K


    This study performed a systems analysis of the process by which patients under the care of a specialist palliative home care obtained medications, and highlighted factors that delay this process. Systems analysis is the science dealing with analysis of complex, large-scale systems and the interactions within those systems. This study used a mixed-methods approach of questionnaires of general practitioners, pharmacists and patients, and a prospective observational study of delays experienced by patients referred to the home care team over a three-month period. This study found the main factors causing delay to be: medications not being in stock in pharmacies, medications not being available on state reimbursed schemes and inability of patients and carers to courier medications.

  11. Community-based care of stroke patients in a rural African setting ...

    to a number of factors including opportunistic infections. HIV-associated ... sought to determine outcomes, family participation and support needs, and implementation .... (US$100) per month with an average of 6 people (all patients had a total ...

  12. Determinants of smoking cessation in COPD patients treated in the outpatient setting

    Tøttenborg, Sandra S; Thomsen, Reimar W; Johnsen, Søren P


    BACKGROUND: The beneficial effects of smoking cessation on the progression of COPD are well established. Nevertheless, many patients with COPD continue to smoke. METHODS: In this nationwide hospital-based prospective follow-up study, we examined rates of smoking cessation and clinical and sociode......BACKGROUND: The beneficial effects of smoking cessation on the progression of COPD are well established. Nevertheless, many patients with COPD continue to smoke. METHODS: In this nationwide hospital-based prospective follow-up study, we examined rates of smoking cessation and clinical...... and sociodemographic determinants of smoking cessation in 3,233 patients with COPD who smoked on outpatient contact during 2008 to 2012. Using multivariate Cox regression, we calculated hazard ratios (HRs) of quitting. RESULTS: Within 1 and 5 years from first outpatient contact, the probability of quitting was 19...... Medical Research Council (MRC) dyspnea scale score reinforce that young and socioeconomically disadvantaged patients have more difficulties achieving...

  13. Quality of care in the oncology outpatient setting from patients' perspective: a systematic review of questionnaires' content and psychometric performance.

    Brédart, A; Kop, J-L; Efficace, F; Beaudeau, A; Brito, T; Dolbeault, S; Aaronson, N


    Cancer care is increasingly provided in the outpatient setting, requiring specific monitoring of care quality. The patients' perspective is an important indicator of care quality and needs to be assessed with well designed, psychometrically sound questionnaires. We performed a systematic literature review of currently available patient satisfaction measures for use in cancer outpatient care settings. We carried out MEDLINE/PubMed, PsycINFO, CINAHL, and Scopus searches of papers published over the past 15 years that describe cancer patient satisfaction questionnaires for use in the outpatient setting. We used the adapted COSMIN checklist to assess the quality of the questionnaires' measurement properties. A total of 6677 citations were identified and 76 relevant articles were read, of which 55 were found either not to be relevant or to provide insufficient psychometric information. The remaining 21 studies pertained to 14 patient satisfaction questionnaires. Continuity and transition, accessibility, and involvement of family/friends were less frequently addressed despite their relevance in outpatient oncology. Almost half of the psychometric studies did not provide information on item level missing data. Most internal consistency estimates (Cronbach's α) were satisfactory. Few studies reported test-retest assessment (n = 5), used confirmatory factor analysis (n = 2), or assessed fit to a graded response item response theory model (n = 3). Only three questionnaires were cross-culturally validated. Important aspects of care may be missed by current patient satisfaction questionnaires for use in the cancer outpatient setting. Additional evidence is needed of their psychometric performance, especially for cross-cultural comparative assessments. Copyright © 2014 John Wiley & Sons, Ltd.

  14. Misdiagnosis trends in patients with hereditary angioedema from the real-world clinical setting

    Zanichelli, Andrea; Longhurst, Hilary J; Maurer, Marcus;


    ) and appendicitis (50 of 185). A variety of other misdiagnoses were reported, including a substantial number of gastrointestinal disorders (excluding appendicitis). Misdiagnosis rates were similar between males (41.1%) and females (46.5%) and between C1-INH-HAE type I (43.7%) and type II (51.6%). Patients...... patients without (1.7 years; P appendicitis. Misdiagnosis results in marked delays in receiving the correct...

  15. 'Co-active coaching' could help HIV patients. New type of counseling involves goal-setting.

    Garfinkel, M; Blumenthal, E


    A counseling technique that takes an action-oriented approach to helping people make major life changes, much used by business executives and other professionals in recent years, now appears to offer some value to HIV patients. Co-active coaching could be a solution to mild depression and inertia for some HIV-infected patients who have difficulty making decisions about how to spend a life-time living with the disease.

  16. Adenomyosis:Pathologies associated in a set of patients underwent hysterectomy

    Luis Humberto Sordia-Hernandez; Julio Herrero; Arturo Morales Martinez; Jose Mara Gris; Donato Saldivar Rodriguez; Oscar Vidal Gutierrez; Celina Castro


    Objective:To determine if a relationship exists between the histopathological diagnosis of adenomyosis and the clinical conditions and pathologies that are more commonly related to it in patients undergoing hysterectomy. Methods:Retrospective, comparative, case-control study was conducted. With previous approval by ethics committee, we included 794 patients undergoing hysterectomy at a University Hospital. The Medical records and pathology reports of patients undergoing hysterectomy over a two-year period were reviwed. Clinical conditions and associated pathologies, in patients with and without adenomyosis, were reviewed and compared. Statistical analysis was done using the Chi-square test. Results:Adenomyosis was reported in 140 out of 794 patients, 17.6%(95%CI:15.1-20.4). No differences in adenomyosis prevalence were found among patients with or without uterine fibroids, 20.2%(75/371) vs. 15.5%(65/423);endometrial polyps, 9.7%(6/62) vs. 18.3%(134/732);and the presence or lack of endometrial hyperplasia 13.9%(5/36) vs. 17.4%(135/758). The prevalence of adenomyosis among patients with endometriosis was 40.7%(11/27), and among those without this diagnosis, 16.8%(129/767). This difference was significant (P=0.001). A history of two or more curettages was also positively related to adenomyosis. Conclusions:There was a statistically significant difference in the prevalence of adenomyosis in women with endometriosis when compared to women without endometriosis. A higher incidence of adenomyosis was found in patients with a history of two or more curettages. Trauma to the endometrium could explain the higher incidence of adenomyosis in both conditions.

  17. Differences in wrist mechanics during the golf swing based on golf handicap.

    Fedorcik, Gregory G; Queen, Robin M; Abbey, Alicia N; Moorman, Claude T; Ruch, David S


    Variation in swing mechanics between golfers of different skill levels has been previously reported. To investigate if differences in three-dimensional wrist kinematics and the angle of golf club descent between low and high handicap golfers. A descriptive laboratory study was performed with twenty-eight male golfers divided into two groups, low handicap golfers (handicap = 0-5, n = 15) and high handicap golfers (handicap ≥ 10, n = 13). Bilateral peak three-dimensional wrist mechanics, bilateral wrist mechanics at ball contact (BC), peak angle of descent from the end of the backswing to ball contact, and the angle of descent when the forearm was parallel to the ground (DEC-PAR) were determined using an 8 camera motion capture system. Independent t-tests were completed for each study variable (α = 0.05). Pearson correlation coefficients were determined between golf handicap and each of the study variables. The peak lead arm radial deviation (5.7 degrees, p = 0.008), lead arm radial deviation at ball contact (7.1 degrees, p = 0.001), and DEC-PAR (15.8 degrees, p = 0.002) were significantly greater in the high handicap group. In comparison with golfers with a low handicap, golfers with a high handicap have increased radial deviation during the golf swing and at ball contact. Copyright © 2011 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  18. Does HIPE data capture the complexity of stroke patients in an acute hospital setting?

    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.

  19. The Association of Types of Training and Practice Settings with Doctors' Empathy and Patient Enablement among Patients with Chronic Illness in Hong Kong.

    Frances S K Yu

    Full Text Available The increase in non-communicable disease (NCD is becoming a global health problem and there is an increasing need for primary care doctors to look after these patients although whether family doctors are adequately trained and prepared is unknown.This study aimed to determine if doctors with family medicine (FM training are associated with enhanced empathy in consultation and enablement for patients with chronic illness as compared to doctors with internal medicine training or without any postgraduate training in different clinic settings.This was a cross-sectional questionnaire survey using the validated Chinese version of the Consultation and Relational Empathy (CARE Measure as well as Patient Enablement Instrument (PEI for evaluation of quality and outcome of care. 14 doctors from hospital specialist clinics (7 with family medicine training, and 7 with internal medicine training and 13 doctors from primary care clinics (7 with family medicine training, and 6 without specialist training were recruited. In total, they consulted 823 patients with chronic illness. The CARE Measure and PEI scores were compared amongst doctors in these clinics with different training background: family medicine training, internal medicine training and those without specialist training. Generalized estimation equation (GEE was used to account for cluster effects of patients nested with doctors.Within similar clinic settings, FM trained doctors had higher CARE score than doctors with no FM training. In hospital clinics, the difference of the mean CARE score for doctors who had family medicine training (39.2, SD = 7.04 and internal medicine training (35.5, SD = 8.92 was statistically significant after adjusting for consultation time and gender of the patient. In the community care clinics, the mean CARE score for doctors with family medicine training and those without specialist training were 32.1 (SD = 7.95 and 29.2 (SD = 7.43 respectively, but the difference was not

  20. Short-term outcomes of type 2 diabetes mellitus patients treated with canagliflozin in real-world setting

    Manash P Baruah


    Full Text Available Objective: This study is aimed to evaluate the characteristics, treatment, and outcomes of patients treated with canagliflozin in the real-world setting within the first 4 months of the product′s availability in India. Patients and Methods: It is a retrospective study with data collected from Indian clinical database. Patients aged 18 and above who were prescribed canagliflozin were included in this study. All the patients were on other antihyperglycemic agents (AHAs before the initiation of canagliflozin. Results: Overall, nine patients were included in the study, and data for these patients with mean duration of follow-up of 16 weeks was analyzed. Mean age was 47.9 years and mean duration of type 2 diabetes was 6.7 years. Among patients with available laboratory data at baseline and follow-up, mean glycosylated hemoglobin A1c (HbA1c decreased from 9.0% at baseline to 6.8% at follow-up (P < 0.005; mean weight reduced from 69.9 kg at baseline to 67.9 kg at follow-up. When compared to baseline, the usage and or dose of other AHAs were reduced during follow-up. Conclusion: Canagliflozin after it became available in India, improved all glycemic parameters and also reduced the weight of the type two diabetic patients who were poorly controlled by multiple AHAs.

  1. Proptosis, Micrognathia, Low Set Ear and Chest Deformity in a Patient with Extra Marker Chromosome 22

    Asieh Mosallanejad


    Full Text Available There is a number of syndromes, associated with proptosis, micrognathia, low-set ear and chest deformity. Herein, we report a 9-year-old female with such phenotype who was presented with a vaginal neuroma. The result of karyotype showed 47XX, with extra marker chromosome 22. Although such a manifestation had not been reported in the literature, it should be considered as a very rare manifestation of the disease.

  2. Health-related quality of life of irritable bowel syndrome patients in different cultural settings

    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.

  3. What influences treatment satisfaction in patients with personality disorders? A naturalistic investigation in a hospitalization setting

    Stefan Gebhardt


    Full Text Available Treatment satisfaction of different mental disorders is still poorly understood, but of high clinical interest. Inpatients of a general psychiatric care hospital were asked to fill out questionnaires on satisfaction at discharge and clinical variables at admission and discharge were assessed. On the basis of an exploratory approach, differences in treatment satisfaction among diagnostic groups were examined by means of one-way analysis of variance. Potential associated clinical and socio-demographic variables were studied using multi/univariate tests. Patients with personality disorders (n=18 showed a significantly lower treatment satisfaction (ZUF-8, Zurich Satisfaction Questionnaire and a slightly lower improvement of symptoms (CGI, Clinical Global Impression and global functioning (GAF, Global Assessment of Functioning scale than that of other diagnostic groups (n=95. Satisfaction in patients with personality disorders correlated much stronger with the symptom improvement and slightly with the functioning level than in patients without personality disorders. Interestingly, in patients with personality disorders psychopharmacological treatment in general (present versus not present was independent from satisfaction. This exploratory investigation suggests that a lower satisfaction of patients with personality disorders in a general psychiatric hospital is mainly based on a reduced improvement of the symptoms and of the global functioning level.

  4. Impact of Sitting or Semi-Setting Position of Patients During Breast Surgery on Hemodynamic Indexes

    Kasra Karvandian


    Full Text Available Background: Keeping the patient in a sitting or semi-sitting position for time-consuming oncoplastic breast surgery is a major challenge for anesthesiologists due to several considerations. This cohort study was conducted on two groups of patients undergoing breast surgery.Methods: Study participants were categorized into two groups: one group was composed of normotensive women (group A and the other group comprised women with controlled hypertension (group B. After the induction of anesthesia in the supine position, the position was changed to sitting and the surgery was done in the sitting position. Hemodynamic monitoring included ECG, heart rate, non-invasive blood pressure (NIBP, invasive blood pressure (IBP, cardiac output (CO, arterial O2 saturation (SPO2, end-tidal CO2 (EtCO2, and bispectral index (BIS. The amount of administrated fluid and vasopressor was recorded for each patient. Any episode of hemodynamic instability was recorded, too.Results: Hemodynamic variation occurred in both groups, but the changes were more significant in group B and the amount of fluid and vasopressor administration was more prominent in group B. Changing the position caused no significant variation in BIS, SPO2, and EtCO2 in the two groups.Conclusions: The sitting position can be safe for time-consuming oncoplastic breast surgery using adequate hemodynamic monitoring. Hemodynamic changes are more significant in patients with controlled hypertension, and more medical interference is needed for these patients.




    Full Text Available PURPOSE: To determine the prevalence and types of glaucoma in rural patients posted for cataract surgery under eye camps at a tertiary care hospital . BACKGROUND: Glaucoma is the second leading cause of blindness in the adult pop ulation in India. The global prevalence of glaucoma for population aged 40 to 80 years is estimated to be 3.54% and the projected number of people with glaucoma worldwide will increase to 111.8 million in 2040. This creates a need for early diagnosis and p rompt management of glaucomas especially in the underprivileged rural areas that lack awareness and facilities. METHODOLOGY: A cross - sectional study was conducted at a regional ophthalmic center for all the patients posted for cataract surgery under eye ca mps. Study was carried out for duration of one year and included 1400 patients. The patients underwent detailed workup to detect the presence of glaucomas and were treated accordingly if the disease was detected. RESULTS: The overall prevalence of glaucoma in our study population was 2.14%. Amongst them, 0.78% had primary open angle glaucoma, 0.14% had primary angle closure glaucoma and 1.21% of them had pseudoexfoliative glaucoma. The prevalence of glaucomas increased with increasing age. CONCLUSION: With increasing life expectancy the number of glaucoma patients is constantly growing large in our country. Early case detection rate is of utmost importance to reduce the disease burden in the rural population where awareness in terms of routine eye screening is very low

  6. [Gastric cancer risk estimate in patients with chronic gastritis associated with Helicobacter pylori infection in a clinical setting].

    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.

  7. Vascular Plug Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varix Bleeding Patients in the Emergent Clinical Setting.

    Kim, Taehwan; Yang, Heechul; Lee, Chun Kyon; Kim, Gun Bea


    To evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results. From April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix. All technical and clinical success-i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control-was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12-32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change. Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding.

  8. Use of intubating laryngeal mask airway in a morbidly obese patient with chest trauma in an emergency setting

    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.

  9. Blood-borne virus transmission in healthcare settings in Ireland: review of patient notification exercises 1997-2011.

    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.

  10. Palliative care for cancer patients in a primary health care setting:Bereaved relatives' experience, a qualitative group interview study

    Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde


    Background: Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primary...... care setting to explore barriers and facilitators for delivery of good palliative home care. Methods: Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results: Three main categories of experience were identified: 1) The health professionals' management, where...... a need to optimize was found. 2) Shared care, which was lacking. 3) The relatives' role, which needs an extra focus. Conclusion: Relatives experience insufficient palliative care mainly due to organizational and cultural problems among professionals. Palliative care in primary care in general needs...

  11. Timing, setting and incidence of cardiovascular complications in patients with acute myocardial infarction submitted to primary percutaneous coronary intervention

    Giglioli, Cristina; Margheri, Massimo; Valente, Serafina; Comeglio, Marco; Lazzeri, Chiara; Chechi, Tania; Armentano, Corinna; Romano, Salvatore Mario; Falai, Massimiliano; Gensini, Gian Franco


    BACKGROUND At the Istituto di Clinica Medica Generale e Cardiologia (Florence, Italy), the widespread use of percutaneous coronary intervention (PCI) has markedly changed the hospital course of patients with acute myocardial infarction (AMI). These patients are typically transferred to the coronary care unit (CCU) only after primary PCI, whereas during the thrombolytic era, patients were first admitted to CCU before reperfusion. OBJECTIVES AND METHODS The incidence, timing and setting of complications from symptom onset to hospital discharge in 689 consecutive AMI patients undergoing PCI were evaluated. RESULTS Ventricular fibrillation occurred in 11% of patients, and most episodes (94.7%) occurred before or during PCI. Of all patients, 6.3% developed complete atrioventricular block (CAVB), and in 86.3% of these cases, the CAVB occurred before or during PCI; in 94.5%, a CAVB resolution occurred in the catheterization laboratory (CL). Thirty-one patients (4.5%) had impending shock on admission to the CL. Cardiogenic shock developed in 29 patients (4.2%), mostly in the prehospital phase or in the CL. Only four patients (less than 1%) developed cardiogenic shock later during their hospital course. Similarly, circulatory and ventilatory support, as well as temporary pacing and cardiac defibrillation, were used mostly in the prehospital phase or in the CL. During the CCU stay, 45 patients (6.5%) had hemorrhagic or vascular complications, and the incidence of post-PCI ischemia and early reocclusion of the culprit vessel were low (2.1% and 0.6%, respectively). Thus, cardiac complications usually associated with AMI were observed mainly before hospital admission or in the CL during the reopening of the target vessel. These complications were rarely observed after a successful PCI. CONCLUSIONS For AMI patients, the CL is not only the site of PCI, it is also where most life-threatening cardiac complications are observed and treated. PMID:17036099

  12. Supraclavicular approach of central venous catheter insertion in critical patients in emergency settings: Re-visited

    Gaurav Singh Tomar


    Full Text Available The supraclavicular approach was first put into clinical practice in 1965 by Yoffa and is an underused method for gaining central access. It offers several advantages over the conventional infraclavicular approach to the subclavian vein. At the insertion site, the subclavian vein is closer to the skin, and the right-sided approach offers a straighter path into the subclavian vein. Also, this site is often more accessible during CPR and surgical procedures. In patients who are obese, this anatomic area is less distorted and in patient with congestive heart failure and cervical spine instability repositioning is not required.

  13. Antibiotic use among patients with febrile illness in a low malaria endemicity setting in Uganda

    Batwala, Vincent; Magnussen, Pascal; Nuwaha, Fred


    randomized to each diagnostic arm (diagnostic method in a defined group of patients). All 52,116 outpatients (presumptive 16,971; microscopy 17,508; and RDT 17,638) aged 5 months to ninety five years presenting with fever (by statement or measured) were included. Information from outpatients and laboratory...... patients who tested negative for malaria, 7809 (61.4%) were prescribed antibiotics in the RDT and 3749 (39.3%) in the microscopy arm. Overall the prescription of antibiotics was more common for children less than five years of age 5,388 (63%) compared to those five years and above 16798 (38...

  14. Assessing Quality of Care of Elderly Patients Using the ACOVE Quality Indicator Set: A Systematic Review

    Askari, M.; Wierenga, P.C.; Eslami, S.; Medlock, S.; de Rooij, S.E.; Abu-Hanna, A.


    Background: Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE) quality indicators (QIs) were developed to assess and improve the care of elderly patients. Objectives: The purpose of this review is to summarize studi

  15. Cone beam CT evaluation of patient set-up accuracy as a QA tool

    Nielsen, Morten; Bertelsen, Anders; Westberg, Jonas;


    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...... error in the calibration of coronal isocentric laser. The observed SD of the systematic error in each direction is 1 mm if a correction is made after the third fraction with an action limit of 4 mm. The SD of the random errors of the patient group is approximately 1 mm in each direction. The rotational...... errors have a vanishing mean and a systematic error of 0.5 1.2 degrees and a random error of 0.40.7 degrees. The uncertainties from the first three treatment sessions (disregarding rotations) lead to a margin of 4 mm from ITV to PTV for Head-and-Neck patients (all directions) and Thorax patients (AP...

  16. Electronic health records and patient safety: co-occurrence of early EHR implementation with patient safety practices in primary care settings.

    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.

  17. Prioritising prevention strategies for patients in Antiretroviral Treatment Programmes in Resource-Limited Settings



    Expanded access to antiretroviral therapy (ART) offers opportunities to strengthen HIV prevention in resource-limited settings. We invited 27 ART programmes from urban settings in Africa, Asia and South America to participate in a survey, with the aim to examine what preventive services had been integrated in ART programmes. Twenty-two programmes participated; 8 (36%) from South Africa, 2 from Brazil, 2 from Zambia and 1 each from Argentina, India, Thailand, Botswana, Ivory Coast, Malawi, Morocco, Uganda and Zimbabwe. Twenty-one sites (96%) provided health education and social support, and 18 (82%) provided HIV testing and counselling. All sites encouraged disclosure of HIV infection to spouses and partners, but only 11 (50%) had a protocol for partner notification. Twenty-one sites (96%) supplied male condoms, 7 (32%) female condoms and 20 (91%) provided prophylactic ART for the prevention of mother-to-child transmission. Seven sites (33%) regularly screened for sexually transmitted infections (STI). Twelve sites (55%) were involved in activities aimed at women or adolescents, and 10 sites (46%) in activities aimed at serodiscordant couples. Stigma and discrimination, gender roles and funding constraints were perceived as the main obstacles to effective prevention in ART programmes. We conclude that preventive services in ART programmes in lower income countries focus on health education and the provision of social support and male condoms. Strategies that might be equally or more important in this setting, including partner notification, prompt diagnosis and treatment of STI, and reduction of stigma in the community, have not been implemented widely. PMID:20473792

  18. Diabetes Health Literacy Among Somali Patients with Diabetes Mellitus in a US Primary Care Setting.

    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. Designing a patient care model with relevance to the cultural setting.

    Robertson-Malt, Suzi; Herrin-Griffith, Donna M; Davies, Joanne


    Healthcare leaders are challenged to develop new approaches to care that better serve populations and use valuable resources in more effective and efficient ways. The authors discuss a model of care under development at Sidra Medical and Research Center, Qatar, with emphasis on how to translate the best available evidence in a way that is applicable and meaningful for the cultural setting. Strategies that nurse leaders can call upon to engage their team members' cultural intelligence during the planning and design of new processes of care are also discussed.

  20. 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.

    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.

  1. A randomised controlled trial of extended brief intervention for alcohol dependent patients in an acute hospital setting (ADPAC

    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

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

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


    of life, symptoms and wellbeing. Patients who visited the outpatient clinic at the Department of Renal Medicine at Aarhus University Hospital in the Central Denmark Region in February and March 2014 and in March and August 2015 were invited to participate. We used a convenience sampling approach...

  3. Patient views on an electronic dispensing device for prepackaged polypharmacy: a qualitative assessment in an ambulatory setting

    Allemann SS


    Full Text Available Samuel S Allemann, Kurt E Hersberger, Isabelle ArnetPharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, SwitzerlandObjective: To collect opinions on medication management aids (MMAs in general and on an electronic MMA (e-MMA dispensing prepackaged polypharmacy in sealed pouches.Study setting: The setting involved community-dwelling older adults in Basel, Switzerland, in 2013.Study design: The study involved 1 a 14-day trial with the e-MMA and 2 a focus group to identify general attributes of MMAs, their applicability to the e-MMA, and possible target groups for the e-MMA.Data collection methods: Six participants using long-term polypharmacy and willing to try new technologies completed the 14-day trial and participated in the focus group. Inductive content analysis was performed to extract data.Principal findings: Participants rated ten of 17 general attributes as clearly applicable to the e-MMA and five as unsuitable. Attributes pertained to three interrelating themes: product design, patient support, and living conditions. Envisaged target groups were patients with time-sensitive medication regimens, patients with dementia, the visually impaired, and several patients living together to prevent accidental intake of the wrong medication.Conclusion: The evaluated e-MMA for prepackaged polypharmacy met the majority of the requirements set for an MMA. Patients' living conditions, such as mobility, remain the key determinants for acceptance of an e-MMA.Keywords: pharmaceutical care, medication adherence, medication management aids, automated drug dispensing

  4. Misdiagnosis trends in patients with hereditary angioedema from the real-world clinical setting

    Zanichelli, Andrea; Longhurst, Hilary J; Maurer, Marcus


    BACKGROUND: Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) causes swelling in the skin and upper airways and pain in the abdomen because of mucosal swelling. C1-INH-HAE is frequently misdiagnosed, leading to delays in diagnosis, inadequate treatment, and unnecessary procedures...... being diagnosed as having C1-INH-HAE. RESULTS: In January 2016, a total of 418 of 633 IOS patients with C1-INH-HAE type I or II had provided misdiagnosis data. Of these, 185 of 418 (44.3%) received 1 or more prior misdiagnoses. The most common misdiagnoses were allergic angioedema (103 of 185...... patients without (1.7 years; P angioedema or appendicitis. Misdiagnosis results in marked delays in receiving the correct...

  5. Risk of Lymphoma and Solid Cancer among Patients with Rheumatoid Arthritis in a Primary Care Setting

    Andersen, Christen Bertel L; Lindegaard, Hanne Merete; Vestergaard, Hanne


    care and 2) the possible mediating role of blood eosinophilia in the clonal evolution of cancer in these patients. METHODS: From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count (DIFF) encompassing...... was stratified according to management in primary or secondary care. From the Danish Cancer Registry we ascertained malignancies within four years following the index DIFF. Using multivariable logistic regression, odds ratios (OR) were calculated and adjusted for sex, age, year, month, eosinophilia, comorbid...... 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...

  6. Successful aging theory and the patient with chronic renal disease: application in the clinical setting.

    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.

  7. Anxiety and Depression among Breast Cancer Patients in an Urban Setting in Malaysia.

    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.

  8. Eye tracking as a debriefing mechanism in the simulated setting improves patient safety practices.

    Henneman, Elizabeth A; Cunningham, Helene; Fisher, Donald L; Plotkin, Karen; Nathanson, Brian H; Roche, Joan P; Marquard, Jenna L; Reilly, Cheryl A; Henneman, Philip L


    Human patient simulation has been widely adopted in healthcare education despite little research supporting its efficacy. The debriefing process is central to simulation education, yet alternative evaluation methods to support providing optimal feedback to students have not been well explored. Eye tracking technology is an innovative method for providing objective evaluative feedback to students after a simulation experience. The purpose of this study was to compare 3 forms of simulation-based student feedback (verbal debrief only, eye tracking only, and combined verbal debrief and eye tracking) to determine the most effective method for improving student knowledge and performance. An experimental study using a pretest-posttest design was used to compare the effectiveness of 3 types of feedback. The subjects were senior baccalaureate nursing students in their final semester enrolled at a large university in the northeast United States. Students were randomly assigned to 1 of the 3 intervention groups. All groups performed better in the posttest evaluation than in the pretest. Certain safety practices improved significantly in the eye tracking-only group. These criteria were those that required an auditory and visual comparison of 2 artifacts such as "Compares patient stated name with name on ID band." Eye tracking offers a unique opportunity to provide students with objective data about their behaviors during simulation experiences, particularly related to safety practices that involve the comparison of patient stated data to an artifact such as an ID band. Despite the limitations of current eye tracking technology, there is significant potential for the use of this technology as a method for the study and evaluation of patient safety practices.

  9. Oral Care of Hospitalised Older Patients in the Acute Medical Setting

    Kathryn Salamone


    Full Text Available Oral health care is an essential aspect of nursing care. There are many variances in the quality and frequency of the oral care that is delivered to patients by nursing staff, such as oral care being given a low priority when compared to other nursing care elements, oral care being neglected, and oral care delivery being dependent on the nurse’s knowledge of oral hygiene. Additionally, there are some particular patient groups known to be at risk of oral health problems or who have existing oral diseases and conditions. As people age their susceptibility increases to chronic and life-threatening diseases, and they can be at increased risk of acute infections increases compromised by ageing immune systems. The aim of this literature review was to ignite the discussion related to the oral care practices of nurses for older acute medical hospitalised patients. The review revealed that nursing staff know that good nursing includes oral health care, but this knowledge does not always mean that oral health care is administered. Oral health care seems to be separated from other nursing activities and is not discussed when nursing care plans are written, only when oral problems are obvious.

  10. Adoptive TIL Transfer in the Adjuvant Setting for Melanoma: Long-Term Patient Survival

    Amir Khammari


    Full Text Available Two first analyses of our clinical trial on TIL as adjuvant therapy for melanoma were published in 2002 and 2007. We present here an update of the clinical results after a 17-year median followup. In this trial, disease-free patients were randomly assigned to receive either TIL/IL-2 or IL-2. The relapse-free survival (RFS was the primary objective. Eighty-eight patients were enrolled. A new analysis performed in May 2013 did not show significant changes in RFS or OS duration. However, our first finding on the association between the number of invaded lymph nodes and TIL effectiveness was strengthened. The Cox model adjusted on this interaction showed for the first time a significant treatment effect when considering the overall population, both on the RFS and OS. Patients treated with TIL had a longer RFS (P=0.023 or OS (P=0.020. This study being with a very long followup (17 years, confirmed the association between TIL effectiveness and the number of invaded lymph nodes, indicating that a low tumor burden could be a crucial factor enhancing the curative effect of TIL in possible microscopic residual disease. Moreover, we confirmed that a prolonged survival was associated with the presence of specific TIL and a decrease in Foxp3 expression.

  11. Quantitative data for care of patients with systemic lupus erythematosus in usual clinical settings: a patient Multidimensional Health Assessment Questionnaire and physician estimate of noninflammatory symptoms.

    Askanase, Anca Dinu; Castrejón, Isabel; Pincus, Theodore


    To analyze quantitative data in patients with systemic lupus erythematosus (SLE), seen in usual care, from a patient Multidimensional Health Assessment Questionnaire (MDHAQ) with routine assessment of patient index data (RAPID3) scores and from a physician global estimate of noninflammatory symptoms; and to compare results to self-report Systemic Lupus Activity Questionnaire (SLAQ) scores and 4 SLE indices: SLE Disease Activity Index-2K (SLEDAI-2K), British Isles Lupus Assessment Group (BILAG), Systemic Lupus Activity Measure (SLAM), and European Consensus Lupus Activity Measurement (ECLAM). Fifty consecutive patients with SLE were studied in usual care of one rheumatologist. All patients completed an MDHAQ/RAPID3 in this setting. Each patient also completed a SLAQ. The rheumatologist scored SLEDAI-2K, BILAG, SLAM, ECLAM, and 2 physician global estimates, one for overall status and one for noninflammatory symptoms. Patients were classified into 2 groups: "few" or "many" noninflammatory symptoms. Scores and indices were compared using correlations, cross-tabulations and t tests. The patients included 45 women and 5 men. MDHAQ/RAPID3 and SLAQ scores were significantly correlated. RAPID3 scores were significantly higher in patients with SLE index scores above median levels, and in 34 patients scored by the rheumatologist as having "few" noninflammatory symptoms. MDHAQ/RAPID3 and SLAQ were significantly higher in 16 patients scored as having many noninflammatory symptoms. MDHAQ/RAPID3 and SLAQ subscale scores appear to reflect disease activity in patients with SLE, but not in patients with many noninflammatory symptoms. A physician scale for noninflammatory symptoms is useful to interpret MDHAQ/RAPID3, SLAQ, and SLE index scores.

  12. A comparative study of set up variations and bowel volumes in supine versus prone positions of patients treated with external beam radiation for carcinoma rectum

    K R Rajeev


    Conclusion: The prone position using BB device was more effective in reducing irradiated SB volume in rectal cancer patients. There were no significant variations in the daily set up for patients treated in both supine and prone positions.

  13. Validity and Reliability of the Hearing Handicap Inventory for Elderly: Version Adapted for Use on the Portuguese Population.

    de Paiva, Sofia Margarida Marques; Simões, João; Paiva, António; Newman, Craig; Castro E Sousa, Francisco; Bébéar, Jean-Pierre


    The use of the Hearing Handicap Inventory for the Elderly (HHIE) questionnaire enables us to measure self-perceived psychosocial handicaps of hearing impairment in the elderly as a supplement to pure-tone audiometry. This screening instrument is widely used and it has been going through adaptations and validations for many languages; all of these versions have kept the validity and reliability of the original version. To validate the HHIE questionnaire, translated into Portuguese of Portugal, on the Portuguese population. This study is a descriptive correlational qualitative study. The authors performed the translation from English into Portuguese, the linguistic adaptation, and the counter translation. Two hundred and sixty patients from the Ear, Nose, and Throat (ENT) Department of Coimbra University Hospitals were divided into a case group (83 individuals) and a control group (177 individuals). All of the 260 patients completed the 25 items in the questionnaire and the answers were reviewed for completeness. The patients volunteered to answer the 25-item HHIE during an ENT appointment. Correlations between each individual item and the total score of the HHIE were tested, and demographic and clinical variables were correlated with the total score, as well. The instrument's reproducibility was assessed using the internal consistency model (Cronbach's alpha). The questions were successfully understood by the participants. There was a significant difference in the HHIE-10 and HHIE-25 total scores between the two groups (p Portuguese of Portugal maintained the validity of the original version and it is useful to assess the psychosocial handicap of hearing impairment in the elderly. American Academy of Audiology.

  14. Objective measures of adoption of patient lift and transfer devices to reduce nursing staff injuries in the hospital setting.

    Schoenfisch, Ashley L; Pompeii, Lisa A; Myers, Douglas J; James, Tamara; Yeung, Yeu-Li; Fricklas, Ethan; Pentico, Marissa; Lipscomb, Hester J


    Interventions to reduce patient-handling injuries in the hospital setting are often evaluated based on their effect on outcomes such as injury rates. Measuring intervention adoption could address how and why observed trends in the outcome occurred. Unit-level data related to adoption of patient lift equipment were systematically collected at several points in time over 5 years on nursing units at two hospitals, including hours of lift equipment use, equipment accessibility, and supply purchases and availability. Various measures of adoption highlighted the adoption process' gradual nature and variability by hospital and between units. No single measure adequately assessed adoption. Certain measures appear well-correlated. Future evaluation of primary preventive efforts designed to prevent patient-handling injuries would be strengthened by objective data on intermediate measures that reflect intervention implementation and adoption. Copyright © 2011 Wiley Periodicals, Inc.

  15. Methods for intraoperative, sterile pose-setting of patient-specific microstereotactic frames

    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.

  16. Generation of an algorithm based on minimal gene sets to clinically subtype triple negative breast cancer patients.

    Ring, Brian Z; Hout, David R; Morris, Stephan W; Lawrence, Kasey; Schweitzer, Brock L; Bailey, Daniel B; Lehmann, Brian D; Pietenpol, Jennifer A; Seitz, Robert S


    Recently, a gene expression algorithm, TNBCtype, was developed that can divide triple-negative breast cancer (TNBC) into molecularly-defined subtypes. The algorithm has potential to provide predictive value for TNBC subtype-specific response to various treatments. TNBCtype used in a retrospective analysis of neoadjuvant clinical trial data of TNBC patients demonstrated that TNBC subtype and pathological complete response to neoadjuvant chemotherapy were significantly associated. Herein we describe an expression algorithm reduced to 101 genes with the power to subtype TNBC tumors similar to the original 2188-gene expression algorithm and predict patient outcomes. The new classification model was built using the same expression data sets used for the original TNBCtype algorithm. Gene set enrichment followed by shrunken centroid analysis were used for feature reduction, then elastic-net regularized linear modeling was used to identify genes for a centroid model classifying all subtypes, comprised of 101 genes. The predictive capability of both this new "lean" algorithm and the original 2188-gene model were applied to an independent clinical trial cohort of 139 TNBC patients treated initially with neoadjuvant doxorubicin/cyclophosphamide and then randomized to receive either paclitaxel or ixabepilone to determine association of pathologic complete response within the subtypes. The new 101-gene expression model reproduced the classification provided by the 2188-gene algorithm and was highly concordant in the same set of seven TNBC cohorts used to generate the TNBCtype algorithm (87%), as well as in the independent clinical trial cohort (88%), when cases with significant correlations to multiple subtypes were excluded. Clinical responses to both neoadjuvant treatment arms, found BL2 to be significantly associated with poor response (Odds Ratio (OR) =0.12, p=0.03 for the 2188-gene model; OR = 0.23, p sets can recapitulate the TNBC subtypes identified by the original 2188

  17. Baseline severe anaemia should not preclude use of zidovudine in antiretroviral-eligible patients in resource-limited settings


    Background Stavudine is no longer recommended as part of first-line therapy for patients initiating antiretroviral therapy (ART) in Uganda. Most patients are currently initiated on zidovudine-containing regimens, which can induce anaemia. We investigated the risk factors for early severe anaemia in the first six months of ART initiation. Methods We defined baseline (ART initiation) anaemia as haemoglobin (Hb) ≤9.5 g/dL, baseline severe anaemia as Hb ≤8 g/dL, and early severe anaemia as Hb ≤8 g/dL within six months of ART initiation. Risk factors for the development of early severe anaemia were analyzed using a multivariable logistic regression model. Results In total, 5494 patients initiated ART, 821 (15%) had baseline anaemia, and 296 (5%) had baseline severe anaemia. Early severe anaemia occurred in 109 (4%) of 3105 patients who had at least one Hb measurement in the first six months on ART. Patients with baseline anaemia had a larger increase in Hb (median g/dL [IQR]) within the first six months compared with non-anaemic patients (2.9 [1.7, 4.6] vs. 0.7 [-0.2, 1.7], p anaemia OR 5.27 (95% CI 3.00 - 9.26) were associated with early severe anaemia. Initiation on a zidovudine-based regimen was not associated with an increased risk of early severe anaemia. Conclusions Among patients in an urban HIV clinic in Uganda, severe anaemia is modestly prevalent at ART initiation and improves with ART in the majority of patients. These data suggest that baseline severe anaemia should not be used as a criterion for avoiding the use of zidovudine in patients initiating ART in resource-limited settings. PMID:21047391

  18. A pilot randomized trial of technology-assisted goal setting to improve physical activity among primary care patients with prediabetes.

    Mann, Devin M; Palmisano, Joseph; Lin, Jenny J


    Lifestyle behavior changes can prevent progression of prediabetes to diabetes but providers often are not able to effectively counsel about preventive lifestyle changes. We developed and pilot tested the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) program to enhance primary care providers' counseling about behavior change for patients with prediabetes. Primary care providers in two urban academic practices and their patients with prediabetes were recruited to participate in the ADAPT study, an unblinded randomized pragmatic trial to test the effectiveness of the ADAPT program, including a streamlined electronic medical record-based goal setting tool. Providers were randomized to intervention or control arms; eligible patients whose providers were in the intervention arm received the ADAPT program. Physical activity (the primary outcome) was measured using pedometers, and data were gathered about patients' diet, weight and glycemic control. A total of 54 patients were randomized and analyzed as part of the 6-month ADAPT study (2010-2012, New York, NY). Those in the intervention group showed an increase total daily steps compared to those in the control group (+ 1418 vs - 598, p = 0.007) at 6 months. There was also a trend towards weight loss in the intervention compared to the control group (- 1.0 lbs. vs. 3.0 lbs., p = 0.11), although no change in glycemic control. The ADAPT study is among the first to use standard electronic medical record tools to embed goal setting into realistic primary care workflows and to demonstrate a significant improvement in prediabetes patients' physical activity.

  19. Efficacy of tolvaptan in patients with refractory ascites in aclinical setting


    AIM To elucidate the efficacies of tolvaptan (TLV)as a treatment for refractory ascites compared withconventional treatment.METHODS: We retrospectively enrolled 120 refractoryascites patients between January 1, 2009 and September31, 2014. Sixty patients were treated with oral TLVat a starting dose of 3.75 mg/d in addition to sodiumrestriction (〉 7 g/d), albumin infusion (10-20 g/wk), andstandard diuretic therapy (20-60 mg/d furosemide and25-50 mg/d spironolactone) and 60 patients with largevolume paracentesis in addition to sodium restriction(less than 7 g/d), albumin infusion (10-20 g/wk), andstandard diuretic therapy (20-120 mg/d furosemide and25-150 mg/d spironolactone). Patient demographicsand laboratory data, including liver function, werenot matched due to the small number of patients.Continuous variables were analyzed by unpaired t -testor paired t -test. Fisher's exact test was applied in casescomparing two nominal variables. We analyzed factorsaffecting clinical outcomes using receiver operatingcharacteristic curves and multivariate regressionanalysis. We also used multivariate Cox's proportionalhazard regression analysis to elucidate the risk factorsthat contributed to the increased incidence of ascites.RESULTS: TLV was effective in 38 (63.3%) patients.The best cut-off values for urine output and reducedurine osmolality as measures of refractory ascitesimprovement were 〉 1800 mL within the first 24 h and〉 30%, respectively. Multivariate regression analysisindicated that 〉 25% reduced urine osmolality [oddsratio (OR) = 20.7; P 〈 0.01] and positive hepatitis Cviral antibodies (OR = 5.93; P = 0.05) were positivelycorrelated with an improvement of refractory ascites,while the total bilirubin level per 1.0 mg/dL (OR = 0.57;P = 0.02) was negatively correlated with improvement.In comparing the TLV group and controls, only theserum sodium level was significantly lower in the TLVgroup (133 mEq/L vs

  20. Profile of patients attending psychogeriatric clinic in a tertiary care setting

    Suresh Neethu


    Full Text Available Background: Proportion of elderly is increasing among the total population of Kerala, and mental health problems of this group are unique. Objectives: To assess the clinical and sociodemographic profile of patients attending Psychogeriatric Clinic in a tertiary care center and to study the correlation of sociodemographic and clinical variables with psychiatric diagnoses in this population. Materials and Methods: A retrospective chart review of patients, who attended the Psychogeriatric Clinic of a tertiary care center over a period of 1 year, was done. The Institutional Ethics Committee discussed and waived clearance for the review. Results: There were 85 cases with a mean age of 69.5 years (standard deviation-7.36. Majority of them were females (56.5% and belonged to low socioeconomic status (52.9%. Comorbid physical illnesses were seen in 76.5% cases. Diagnoses were made by Junior Residents in Psychiatry and confirmed by a qualified psychiatrist, as per International Classification of Diseases-10 criteria. The most common psychiatric diagnosis was organic mental disorders (24.7%, which included dementias, delirium, and organic mood disorders. This was followed by bipolar affective disorders (22.4%, schizophrenia and related disorders (20.0%, depressive and anxiety disorders (17.6% and mental and behavioral disorders due to substance use (2.4%. Occurrence of organic psychiatric disorders showed positive correlation with age (Spearman's ρ =0.253, P = 0.02 and occurrence of hypertension (ρ =0.222, P = 0.04. Conclusions: Organic psychiatric disorders are more common in elderly patients attending a tertiary care center. Comorbid physical illnesses are seen in more than three-fourths of this population. Organic psychiatric disorders are seen more commonly with increasing age and occurrence of hypertension.

  1. Validation of a Cochlear Implant Patient Specific Model of the Voltage Distribution in a Clinical Setting

    Waldo Nogueira


    Full Text Available Cochlear Implants (CIs are medical implantable devices that can restore the sense of hearing in people with profound hearing loss. Clinical trials assessing speech intelligibility in CI users have found large inter-subject variability. One possibility to explain the variability is the individual differences in the interface created between electrodes of the CI and the auditory nerve. In order to understand the variability, models of the voltage distribution of the electrically stimulated cochlea may be useful. With this purpose in mind, we developed a parametric model that can be adapted to each CI user based on landmarks from individual cone beam computed tomography (CBCT scans of the cochlea before and after implantation. The conductivity values of each cochlea compartment as well as the weighting factors of different grounding modes have been also parameterized. Simulations were performed modeling the cochlea and electrode positions of 12 CI users. Three models were compared with different levels of detail: A homogeneous model (HM, a non-patient specific model (NPSM and a patient specific model (PSM. The model simulations were compared with voltage distribution measurements obtained from the backward telemetry of the 12 CI users. Results show that the PSM produces the lowest error when predicting individual voltage distributions. Given a patient specific geometry and electrode positions we show an example on how to optimize the parameters of the model and how to couple it to an auditory nerve model. The model here presented may help to understand speech performance variability and support the development of new sound coding strategies for CIs.

  2. People with symptoms of Ménière's disease: the relationship between illness intrusiveness, illness uncertainty, dizziness handicap, and depression.

    Arroll, Megan; Dancey, Christine P; Attree, Elizabeth A; Smith, Sharon; James, Trevor


    The goal of this study was to assess the impact of dizziness handicap, illness intrusiveness (in relation to vertigo, tinnitus, and hearing problems), and illness uncertainty on depression in people with the symptoms of Ménière's disease. Ménière's disease is a progressive disease of the inner ear, the symptoms of which are vertigo, tinnitus, hearing loss, and aural fullness. Although pharmacologic treatments may reduce acute vertigo spells and dizziness, they rarely disappear entirely. Previous research shows that Ménière's disease is unpredictable and has a negative impact on patients' quality of life. Questionnaires measuring Dizziness Handicap, Illness Intrusiveness, Illness Uncertainty, and Depression were completed by 74 people with self-reported symptoms of Ménière's disease. Bivariate correlations, repeated-measures analysis of variance, and multiple regression analyses were used to assess the contribution of dizziness handicap, illness intrusiveness, and illness uncertainty to depression. Vertigo was more intrusive than tinnitus, hearing problems, and most other comparator illnesses. The intrusiveness of the symptoms of Ménière's disease accounted for 32% of the variance in depression scores, which were high; illness uncertainty did not account for additional variance. Dizziness handicap accounted for 31% of the variation in depression. Although the symptoms of Ménière's disease may not be alleviated by psychological methods, programs that target cognitions in relation to the embarrassment in front of others, and the feeling of being handicapped, may lessen the psychosocial impact of the symptoms of Ménière's disease, which may reduce some of the depression felt in this group.

  3. Antibiotic use among patients with febrile illness in a low malaria endemicity setting in Uganda

    Batwala, Vincent; Magnussen, Pascal; Nuwaha, Fred


    Background: Uganda embraced the World Health Organization guidelines that recommend a universal 'test and treat' strategy for malaria, mainly by use of rapid diagnostic test (RDT) and microscopy. However, little is known how increased parasitological diagnosis for malaria influences antibiotic...... randomized to each diagnostic arm (diagnostic method in a defined group of patients). All 52,116 outpatients (presumptive 16,971; microscopy 17,508; and RDT 17,638) aged 5 months to ninety five years presenting with fever (by statement or measured) were included. Information from outpatients and laboratory...


    Fastenemeier Heribert


    Full Text Available The demographic evolution and its consequences – population ageing - have been the topic of multiple research studies and analyses in many countries, industries or political regimes. Health care systems have been faced with questions regarding future financing, organization and resource allocation under the impact of the demographic evolution. This time is the hospital sector in focus. Analyzing the situation in German hospitals on the basis of recent, detailed statistical data and studies, this paper provides information, data and figures on elderly hospitalized patients with regard to costs, diagnoses and operations and presents briefly implications of the demographic evolution and of an ageing population for hospitals.

  5. The Correlation of the Tinnitus Handicap Inventory with Depression and Anxiety in Veterans with Tinnitus

    Jinwei Hu


    Full Text Available Objective. The mechanisms of tinnitus are known to alter neuronal circuits in the brainstem and cortex, which are common to several comorbid conditions. This study examines the relationship between tinnitus and anxiety/depression. Subjects and Methods. Ninety-one male veterans with subjective tinnitus were enrolled in a Veterans Affairs Tinnitus Clinic. The Tinnitus Handicap Inventory (THI was used to assess tinnitus severity. ICD-9 codes for anxiety/depression were used to determine their prevalence. Pure tone averages (PTA were used to assess hearing status. Results. Descriptive analyses revealed that 79.1% of the 91 tinnitus sufferers had a diagnosis of anxiety, 59.3% had depression, and 58.2% suffered from both anxiety/depression. Patients with anxiety had elevated total THI scores as compared to patients without anxiety (p<0.05. Patients with anxiety or depression had significantly increased Functional and Emotional THI scores, but not Catastrophic THI score. Significant positive correlations were illustrated between the degree of tinnitus and anxiety/depression (p<0.05. There were no differences in PTA among groups. Conclusions. A majority of patients with tinnitus exhibited anxiety and depression. These patients suffered more severe tinnitus than did patients without anxiety and depression. The data support the need for multidisciplinary intervention of veterans with tinnitus.

  6. Automatization of Mathematics Skills via Computer-Assisted Instruction among Students with Mild Mental Handicaps.

    Podell, David M.; And Others


    This evaluation study with 94 elementary students (50 with mild mental handicap) compared computer-assisted instruction (CAI) and paper-and-pencil practices in promoting automatization of basic addition and subtraction skills. Findings suggested CAI was more effective but that the students with mental handicap required more practice than…

  7. Trait self-esteem and claimed self-handicapping motives in sports situations.

    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.

  8. Preschool Siblings of Handicapped Children: Interactions with Mothers, Brothers, and Sisters.

    Lobato, Debra J.; And Others


    This study, involving 40 young siblings of either handicapped or nonhandicapped children, found that siblings of handicapped children engaged in more parallel and social play and were more nurturing with their siblings than were control children. Mothers were more likely to deliver commands, directives, and reprimands to siblings of handicapped…

  9. Placing Handicapped Students in the Least Restrictive Environment: An Adapted Model for Decision Makers.

    Makuch, Gary; And Others

    Intended for local school district personnel, the document suggests a model for assisting decision makers in placing handicapped students in the least restrictive environment (LRE). Basic considerations of a multidisciplinary team in determining the appropriate placement for the handicapped students are listed (including the nature and degree of…

  10. Library Services for the Handicapped in Maine; A State-of-the-Art Report.

    Martin, Patrick A.

    The purpose of this state-of-the-art report is to describe how handicapped readers in Maine receive their special library services as part of the national network. Handicapped readers are defined as those persons who are unable to read conventional print or handle conventionally printed materials because of some visual or physical impairment. The…

  11. Chronically Ill and Handicapped Children and Adolescents: Personality Studies in Relation to Disease.

    Steinhausen, Hans-Christoph


    Personality was studied in three groups of chronically ill (diabetic or hemophiliac) and physically handicapped children and adolescents (N=104, mean age 13 years) and compared to that of healthy control groups. Among physically handicapped children a pattern emerged indicating lack of emotional integration into environment without conflict.…

  12. Special Needs in Education (E241): Biology and Handicap, Unit 11.

    Potts, Patricia

    One of 16 booklets designed for use in an Open University course on the education of handicapped students in the United Kingdom, this document considers biological factors involved in handicapping conditions. An initial chapter examines the portrayal of disabled persons in drama, literature and film. Genetic involvement (autosomal dominant…

  13. A Comparative Study of Handicap-Free Life Expectancy of China in 1987 and 2006

    Lai, Dejian


    After the first large scale national sampling survey on handicapped persons in 1987, China conducted its second national sampling survey in 2006. Using the data from these two surveys and the national life tables, we computed and compared the expected years of life free of handicapped condition by the Sullivan method. The expected years of life…

  14. 41 CFR 50-201.1102 - Tolerance for apprentices, student-learners, and handicapped workers.


    ..., student-learners, and handicapped workers. 50-201.1102 Section 50-201.1102 Public Contracts and Property... REGULATIONS § 50-201.1102 Tolerance for apprentices, student-learners, and handicapped workers. (a... standards and procedures as are prescribed for the employment of apprentices, student-learners,...

  15. The double whammy of a work handicap (differential) effects of health on working conditions and outcomes.

    Steenbeek, Romy; Giesen, Femke B M; Ybema, Jan Fekke


    To determine the effect of health on working conditions and outcomes. Data were collected in the longitudinal Study on Health at Work (n = 1597 employees), using multiple regression analyses and focusing on three groups of employees: 1) healthy, 2) chronic health complaints without a work handicap, and 3) chronic health complaints with a work handicap. 1) Employees with a work handicap experienced less favorable working conditions and outcomes than other employees. 2) Employees with a work handicap experienced less favorable working conditions and outcomes over time. 3) Employees with chronic health complaints were more vulnerable to the influence of working conditions on outcomes, whereas employees with a work handicap, unexpectedly, benefited from high work pressure and low autonomy. 1) Employees with a work handicap differ considerably from employees with chronic health complaints. 2) Employees with a work handicap drift into less favorable working conditions and outcomes. 3) Healthy employees, employees with chronic health complaints, and employees with a work handicap, all are vulnerable to different working conditions.

  16. Handicap og beskæftigelse: Udviklingen mellem 2002 og 2005

    Høgelund, Jan; Mølgaard Miiller, Max; Pico Geerdsen, Peter

    Personer med handicap har en markant svagere tilknytning til arbejdsmarkedet end personer uden handicap. Den lave beskæftigelsesgrad blandt handicappede har flere negative konsekvenser både på det personlige og det samfundsmæssige plan. Denne rapport belyser udviklingen i beskæftigelsen af person...

  17. Academic Self-Handicapping: The Role of Self-Concept Clarity and Students' Learning Strategies

    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…

  18. The Origin of the Term Handicap in Games and Sports – History of a Concept

    Hansen Jørn


    Full Text Available Words and concepts may change in time, and this has certainly been the case with the term handicap. From the establishment of modern sports in the middle of the 19th century and up until the middle of the 20th century, handicap had an entirely different meaning within sports. Thus, handicap was understood as a disadvantage imposed on talented contestants to make the competition more equal in sports. Later the term handicap became much closer related to the concepts invalid and crippled than to concept originally employed within sports, With the gradual introduction of the welfare state measures to the political agenda the politicians in Denmark also started to take an interest in invalids and cripples and in 1925 the National Association of the Crippled and Maimed was founded. By the end of the 20 century the term crippled was seen by many as outdated and in 1988 the name was changed to the Danish Association for the Disabled (Dansk Handicap Forbund and already in 1971 this organization helped to found The Danish Disabled Sports Association (Dansk Handicap Idræts-Forbund. The article tells the story of how the concept of handicap, which originally was an aim to provide equal opportunities, today has become a synonym for disability, while in the Paralympics and competitive disability sports, the original sports term handicap has been replaced by classification.

  19. Development and validation of the Dutch version of the London Handicap Scale

    Groothuis-Oudshoorn, C.G.M.; Chorus, A.M.J.; Verrips, G.H.W.; Detmar, S.B.


    BACKGROUND: The London Handicap Scale (LHS) was found to be a valid and reliable scale for measuring participation restrictions in adults. OBJECTIVE: This paper describes the development and assesses the construct-related validity of a Dutch version of the London Handicap Scale (DLHS). METHODS: The

  20. Resource Catalogue for Teachers of Severely Handicapped Students. Program Assistance Report No. 10.

    Wenner, Lynette; And Others

    Intended for teachers and other personnel working with severely/multiply handicapped students, the catalogue lists books and journal articles (1975-1981) related to special education for severely/multiply handicapped students. Following an introduction discussing definitional issues, entries are alphabetized by title and arranged according to one…

  1. The Development of Concepts of Handicap in Adolescence: A Cross-Cultural Study-Part I.

    Doherty, Jim; Obani, Tim


    Reports the results of quasi-experimental study of 155 Nigerian and 151 British boys' and girls' understanding of handicaps. Presents information regarding the content of the questionnaire, which posed both direct and indirect questions regarding causality, effects, rehabilitation and interaction of handicapped persons. (JDH)

  2. Electromyographic Analysis of the Lower Limb Muscles in Low- and High-Handicap Golfers

    Marta, Sérgio; Silva, Luís; Vaz, João R.; Castro, Maria António; Reinaldo, Gustavo; Pezarat-Correia, Pedro


    Purpose: The aim of this study was to compare the electromyographic patterns of the lower limb muscles during a golf swing performed by low- and high-handicap golfers. Method: Ten golfers (5 low- and 5 high-handicap) performed 8 swings using a 7-iron. Surface electromyography (EMG) was recorded for the following lower limb muscles on both sides:…

  3. School-to-Work Transition for Handicapped Youth: Perspectives on Educational and Economic Trends.

    Repetto, Jeanne B., Ed.

    This compilation of papers focuses on the economic and educational considerations required for planning transitional services for handicapped youth, and was developed from the second and third annual forums sponsored by the Transitional Programming for Handicapped Youth: Interdisciplinary Leadership Preparation Program at the University of…

  4. A Plan for Itinerant Educational Consultant Services for Preschool Visually Handicapped Children.

    Allegheny County Schools, Pittsburgh, PA.

    A demonstration project was conducted involving itinerant educational consultant services for preschool visually handicapped children with the objective of preventing social and sensory deprivation and of developing personal independence. Channels were established for referral of applicable visually handicapped preschool children to the program.…

  5. KI-Aikido for Handicapped Students at Leeward Community College: Theory and Practice.

    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…

  6. Tracking Restoration of Park and Urban Street Settings in Coronary Artery Disease Patients

    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.

  7. The reliability of lung crackle characteristics in cystic fibrosis and bronchiectasis patients in a clinical setting.

    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.

  8. Social meanings and understandings in patient-nurse interaction in the community practice setting: a grounded theory study.

    Stoddart, Kathleen M


    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. 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. 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. The importance of social meanings and understandings in patient-nurse interaction is not fully apparent to

  9. Characteristics and outcome of patients with primary CNS lymphoma in a "real-life" setting compared to a clinical trial.

    Zeremski, Vanja; Koehler, Michael; Fischer, Thomas; Schalk, Enrico


    We aimed to compare the characteristics and outcome of patients treated within the multi-centre German Primary CNS Lymphoma Study Group 1 trial (G-PCNSL-SG-1; TRIAL group) and patients treated outside this clinical trial ("real-life" setting, R-LIFE group). Therefore, we conducted a retrospective single-centre study in order to analyse all patients with newly diagnosed primary CNS lymphoma (PCNSL) treated consecutively in our institution between November 2000 and June 2015. Altogether, 86 patients were analysed (median 68 years). Twenty patients were treated within (TRIAL) and 66 patients outside the clinical trial (R-LIFE), respectively. The majority (n = 75; 87 %) received high-dose methotrexate as the first-line treatment. Thirty-eight of 66 patients (57.6 %) responded to the first-line therapy. The R-LIFE patients were older (median age 70 vs. 62 years; p = 0.005) and had more frequently a worse performance status (ECOG score 2-4: 59.1 vs. 20.0 %; p = 0.004; median Karnofsky index 70 vs. 80 %; p = 0.003) and less frequently a low prognostic score (IELSG score 0-1: 19.7 vs. 45.0 %; p = 0.038), than the TRIAL patients. Median overall survial (OS) was shorter for the R-LIFE patients (9.3 months [95 % CI 1.9-16.7] vs. 33.4 months [95 % CI 17.6-49.2]; p = 0.065). Median progression-free survival (PFS) was significantly inferior for the R-LIFE patients (3.4 months [95 % CI 2.4-4.4] vs. 24.8 months [95 % CI 4.6-45.0]; p = 0.037). Our data indicate that the outcome of PCNSL patients treated outside, but about analogous to the G-PCNSL-SG-1 trial, was poor. This is likely explained by more unfavourable prognostic factors in patients being treated off trial.

  10. Group therapy for spouses of aphasic patients.

    Johannsen-Horbach, H; Crone, M; Wallesch, C W


    The setting, course, and results of a counseling and a therapeutic group for relatives of chronic aphasic patients are reviewed. Generally, providing and discussing information on the illness, its consequences, and medical and social services are greatly appreciated by group members. Counseling and group psychotherapy, as conducted by us, did not result in measurable improvements of relatives' perceptions of personal, social, and familial burdens. We assume, however, that group therapy does lead to more realistic attitudes toward burdensome and severely straining situations and may help with coping. Further research into psychotherapeutic strategies for relatives of disabled persons, who themselves suffer from psychological and social handicaps, is needed.

  11. Follow-up of ischemic cardiopathy, an essential moment in the communication between in-patient and out-patient setting: problems and opportunities

    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.

  12. Paediatric oncology patient preference for oral nutritional supplements in a clinical setting.

    Cohen, Jennifer; Rosen, Kate; Russell, Ken K; Wakefield, Claire E; Goodenough, Belinda


    Oral nutrition supplements are commonly used to increase the nutrient intake of children who are undergoing treatment for cancer. However, little research has been conducted systematically examining preferences for oral supplements in this population. This study aims to address a gap in the literature by examining taste preferences of oral nutrition supplements routinely recommended for children undergoing treatment for cancer. Twenty-one children undergoing treatment for cancer and 38 healthy control subjects participated in an acute double-blinded feeding trial. A variety of energy drinks, available both commercially and in the hospital, were sampled. Patients rated the taste of the drinks on a 10-cm coloured analogue scale. A commercially-based drink (Moove™) rated the highest in the blinded and branded tests for the treatment (mean rating out of 10, 6.44±2.69 and 7.26±2.33, respectively) and control groups (mean rating, 7.61±1.91 and 7.70±2.32, respectively). Taste ratings were significantly higher for commercially available supplements over the hospital-prepared supplements, (p=0.041), with no main effect for tasting condition (i.e. blinded versus branded, p=0.902). There was a statistically significant trend such that ratings, when the brand that was known decreased for hospital supplements, while ratings for commercially available supplements increased (p=0.014). Fresh milk-based supplements were the preferred type of oral nutrition supplement in a cohort of paediatric oncology patients. The data also suggest that commercially available products are more likely to be accepted than hospital-prepared supplements. This pilot study supports the need for further research in the area of oral nutrition supplements for paediatric oncology patients as a way of determining a reliable way to estimate preferences and therefore maximise compliance. Results from this research could be also used as the basis for designing research to study the effects of flavour

  13. Health economic burden of patients with restless legs syndrome in a German ambulatory setting.

    Dodel, Richard; Happe, Svenja; Peglau, Ines; Mayer, Geert; Wasem, Jürgen; Reese, Jens-Peter; Giani, Guido; Geraedts, Max; Trenkwalder, Claudia; Oertel, Wolfgang H; Stiasny-Kolster, Karin


    The primary characteristics of restless legs syndrome (RLS), including severe sleep disorders, restlessness in the evening and discomfort while at rest, have substantial impact on normal daily activities. Because of the high prevalence of RLS in the general population, it is necessary to evaluate the economic impact of RLS. To determine the health economic burden of patients with RLS in Germany. A total of 519 RLS patients (mean age: 65.2 +/- 11.1 years) in different stages of disease were recruited in five health centres (university hospitals, district hospitals and office-based neurologists) by applying the diagnostic criteria of the International Restless Legs Syndrome Study Group. A questionnaire was administered that assessed healthcare resource consumption as well as socioeconomic, demographic, clinical and health status. In addition, the International RLS severity scale (IRLS), Epworth Sleepiness Scale (ESS), EQ-5D and Beck Depression Inventory (BDI) were addressed in the assessment. Direct and indirect costs (euro, year 2006 values) were derived from various German economic resources and calculated from the perspective of the healthcare and transfer payment providers. We calculated average total costs over the 3-month observation period. It was determined that average total costs were euro2090 for this period. The average direct medical and non-medical costs from the perspective of the health insurance provider were determined to be euro780, with euro300 attributed to drug costs and euro354 to hospitalization costs. Average total indirect costs amounted to euro1308 and were calculated based on productivity loss, using the human capital approach. As cost-driving factors we identified disease severity according to the IRLS (p < 0.01) and ESS (p < 0.04). Health-related quality of life was determined to be substantially affected by RLS; the mean EQ-5D visual analogue scale (VAS) was 55.6, considerably lower than that of the age-matched general population. RLS

  14. Patient characteristics among users of analgesic over-the-counter aspirin in a Danish pharmacy setting.

    Pottegård, Anton; Kviesgaard, Ann-Katrine; Hesse, Ulrik; Moreno, Søren Ilsøe; Hansen, Jane Møller


    Use of over-the-counter (OTC) high-dose acetylsalicylic acid (ASA) is a risk factor for experiencing gastric bleeding. However, more detailed knowledge on the characteristics of users of OTC ASA is needed. To characterise users of OTC high-dose ASA in a Danish pharmacy setting. We conducted an interview based survey among users of OTC high-dose ASA. Questions were asked regarding: (1) demographic characteristics; (2) use patterns; (3) knowledge about adverse events; (4) risk factors for experiencing gastric bleeding; (5) reasons for choosing an ASA-containing medicine; and (6) whether their GP was informed on their use of high-dose ASA. One-hundred-seventeen interviews were completed. Nineteen percent and 37 % used high-dose ASA on a daily or weekly basis respectively. Sixty-eighth percent found high-dose ASA to be more effective than other analgesics. Fourty-seven percent had one or more risk factors for experiencing ulcer bleeding, most commonly age >60 years (32 %) and previous peptic ulcer (9 %). The most well-known adverse events were abdominal pain (32 %) and peptic ulcer (26 %). The most common source of information was friends and family (32 %). A large proportion of users of high-dose ASA have risk factors for experiencing gastric bleeding. Health-care professionals needs to provide more information on potential adverse events.

  15. Complementary alternative medicine use among patients with dengue fever in the hospital setting: a cross-sectional study in Malaysia.

    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.

  16. Use of email in a family practice setting: opportunities and challenges in patient- and physician-initiated communication

    Scannell Margaret A


    Full Text Available Abstract Background Electronic mail (email has the potential to improve communication between physicians and patients. Methods We conducted two research studies in a family practice setting: 1 a brief, anonymous patient survey of a convenience sample to determine the number of clinic patients receptive to communicating with their physician via email, and 2 a randomized, controlled pilot study to assess the feasibility of providing health education via email to family practice patients. Results Sixty-eight percent of patients used email, and the majority of those (80% were interested in using email to communicate with the clinic. The majority also reported that their email address changed less frequently than their home address (65%, n = 173 or telephone number (68%, n = 181. Forty-two percent were willing to pay an out-of-pocket fee to have email access to their physicians. When evaluating email initiated by the clinic, 26% of otherwise eligible patients could not participate because they lacked email access; those people were more likely to be black and to be insured through Medicaid. Twenty-four subjects agreed to participate, but one-third failed to return the required consent form by mail. All participants who received the intervention emails said they would like to receive health education emails in the future. Conclusion Our survey results show that patients are interested in email communication with the family practice clinic. Our feasibility study also illustrates important challenges in physician-initiated electronic communication. The 'digital divide' – decreased access to electronic technologies in lower income groups – is an ethical concern in the use of email for patient-physician communication.

  17. [Injury risk of competitive, handicapped cross-country skiers in training nd competition].

    Schmid, A; Hüring, H; Huber, G; Gösele, A; Hecker-Kube, H; Gruhn, O; Stinus, H; Birnesser, H; Keul, J


    Injuries caused by cross country skiing have been poorly investigated in handicapped athletes. The dynamic sliding shape of motion makes this sport to a suitable discipline for people with a deficit of locomotion. Visual handicapped people with a guide are able to improve their motoric skills, co-ordination, orientation and body self-consciousness in the track. Since handicapped athletes are performing in international competitions the training intensity to fulfill the requirements, but also the risk of overstrain induced injuries got increased, like in other high-performance sports. Our study examined injuries and overuse syndromes of the German National Team Ski Nordic during the Paralympics in Tignes/ Albertville (1992). Lillehammer (1994) and the training period in preparation for the Paralympics in Nagano (March 1998). The incidence and kind of injuries in the competitive handicapped cross country skier was comparable with non-handicapped athletes, but the injury pattern was different.

  18. Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings.

    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.

  19. Upper gastrointestinal endoscopy in emergency setting for patients receiving oral anticoagulants – practice updates

    Oprita, R; Oprita, B; Diaconescu, B; Bratu, MR; Berceanu, D


    Anticoagulants are frequently used medications in diverse cardiovascular diseases. Their uses highly increase the risk of bleeding from upper and lower gastrointestinal sources, whether there is a classic vitamin K antagonist or a novel oral anticoagulant. Their interruption can promote procoagulation status with different thromboembolic accidents. Discontinuation of oral anticoagulants before the elective procedures is standardized but there are no guidelines for managing bleeding lesions of upper gastrointestinal tract concomitant with anticoagulation. Also, because some of the anticoagulants are new comers, there is no specific antidote, and so their anticoagulation effect cannot be antagonized fast in order to reduce the bleeding. Therefore, the endoscopic hemostasis must be definitive and efficient. This is a short review of the current management for the bleeding lesions of the upper gastrointestinal tract in patients taking oral anticoagulants. PMID:28255372

  20. Ethics of professional relations to functionally handicapped users

    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.