Moffat, M.; Cleland, J.; Van der Molen, T.; Price, D.
Introduction: Asthma control can be influenced by a range of non-medical issues, including psychosocial factors. Little is known about the views of patients, particularly those with severe and/or difficult asthma, towards their asthma control and their asthma-related primary care consultations. Aims
Pype, Peter; Teuwen, Inge; Mertens, Fien; Sercu, Marij; De Sutter, An
Palliative sedation is a therapeutic option to control refractory symptoms in terminal palliative patients. This study aims at describing the occurrence and characteristics of suboptimal palliative sedations in primary care and at exploring the way general practitioners (GPs) experience suboptimal palliative sedation in their practice. We conducted a mixed methods study with a quantitative prospective survey in primary care and qualitative semi-structured interviews with GPs. The research team defined suboptimal palliative sedation as a time interval until deep sleep >1.5 h and/ or >2 awakenings after the start of the unconsciousness. Descriptive statistics were calculated on the quantitative data. Thematic analysis was used to analyse interview transcripts. We registered 63 palliative sedations in 1181 home deaths, 27 forms were completed. Eleven palliative sedations were suboptimal: eight due to the long time span until deep sleep; three due the number of unintended awakenings. GPs' interview analysis revealed two major themes: the shifting perception of failure and the burden of responsibility. Suboptimal palliative sedation occurs frequently in primary palliative care. Efficient communication towards family members is needed to prevent them from having unrealistic expectations and to prevent putting pressure on the GP to hasten the procedure. Sharing the burden of decision-making during the procedure with other health care professionals might diminish the heavy responsibility as perceived by GPs.
Mazenga, Alick C.; Simon, Katie; Yu, Xiaoying; Ahmed, Saeed; Nyasulu, Phoebe; Kazembe, Peter N.; Ngoma, Stanley; Abrams, Elaine J.
Background The well-documented shortages of health care workers (HCWs) in sub-Saharan Africa are further intensified by the increased human resource needs of expanding HIV treatment programs. Burnout is a syndrome of emotional exhaustion (EE), depersonalization (DP), and a sense of low personal accomplishment (PA). HCWs’ burnout can negatively impact the delivery of health services. Our main objective was to examine the prevalence of burnout amongst HCWs in Malawi and explore its relationship to self-reported suboptimal patient care. Methods A cross-sectional study among HCWs providing HIV care in 89 facilities, across eight districts in Malawi was conducted. Burnout was measured using the Maslach Burnout Inventory defined as scores in the mid-high range on the EE or DP subscales. Nine questions adapted for this study assessed self-reported suboptimal patient care. Surveys were administered anonymously and included socio-demographic and work-related questions. Validated questionnaires assessed depression and at-risk alcohol use. Chi-square test or two-sample t-test was used to explore associations between variables and self-reported suboptimal patient care. Bivariate analyses identified candidate variables (p burnout. In the three dimensions of burnout, 55% reported moderate-high EE, 31% moderate-high DP, and 46% low-moderate PA. The majority (89%) reported engaging in suboptimal patient care/attitudes including making mistakes in treatment not due to lack of knowledge/experience (52%), shouting at patients (45%), and not performing diagnostic tests due to a desire to finish quickly (35%). In multivariate analysis, only burnout remained associated with self-reported suboptimal patient care (OR 3.22, [CI 2.11 to 4.90]; pBurnout was common among HCWs providing HIV care and was associated with self-reported suboptimal patient care practices/attitudes. Research is needed to understand factors that contribute to and protect against burnout and that inform the
Tan, Ming Yeong; Magarey, Judy
To investigate the self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control. Using a one-to-one interviewing approach, data were collected from 126 diabetic adults from four settings. A 75-item questionnaire was used to assess diabetes-related knowledge and self-care practices regarding, diet, medication, physical activity and self-monitoring of blood glucose (SMBG). Most subjects had received advice on the importance of self-care in the management of their diabetes and recognised its importance. Sixty-seven subjects (53%) scored below 50% in their diabetes-related knowledge. Subjects who consumed more meals per day (80%), or who did not include their regular sweetened food intakes in their daily meal plan (80%), or who were inactive in daily life (54%), had higher mean fasting blood glucose levels (p=0.04). Subjects with medication non-adherence (46%) also tended to have higher fasting blood glucose levels. Only 15% of the subjects practiced SMBG. Predictors of knowledge deficit and poor self-care were low level of education (p = <0.01), older subjects (p=0.04) and Type 2 diabetes subjects on oral anti-hyperglycaemic medication (p = <0.01). There were diabetes-related knowledge deficits and inadequate self-care practices among the majority of diabetic patients with sub-optimal glycaemic control. This study should contribute to the development of effective education strategies to promote health for adults with sub-optimal diabetes control.
Esscher, Annika; Binder-Finnema, Pauline; Bødker, Birgit
that occurred in Sweden from 1988-2010. METHODS: A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases...... language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups. CONCLUSIONS: Suboptimal care factors, major...
Esscher, Annika; Binder-Finnema, Pauline; Bødker, Birgit; Högberg, Ulf; Mulic-Lutvica, Ajlana; Essén, Birgitta
Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths that occurred in Sweden from 1988-2010. A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases of maternal death. An assessment protocol was developed that applied both the 'migration three delays' framework and a modified version of the Confidential Enquiry from the United Kingdom. The main outcomes were major and minor suboptimal factors associated with maternal death in this high-income, low-maternal mortality context. Major and minor suboptimal factors were associated with a majority of maternal deaths and significantly more often to foreign-born women (p = 0.01). The main delays to care-seeking were non-compliance among foreign-born women and communication barriers, such as incongruent language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups. Suboptimal care factors, major and minor, were present in more than 2/3 of maternal deaths in this high-income setting. Those related to migration were associated to miscommunication, lack of professional interpreters, and limited knowledge about rare diseases and pregnancy complications. Increased insight into a migration perspective is advocated for maternity clinicians who provide care to foreign-born women.
Liang, Ying-Zhi; Chu, Xi; Meng, Shi-Jiao; Zhang, Jie; Wu, Li-Juan; Yan, Yu-Xiang
The study aimed to develop and validate a model to measure psychosocial factors at work among medical staff in China based on confirmatory factor analysis (CFA). The second aim of the current study was to clarify the association between stress-related psychosocial work factors and suboptimal health status. The cross-sectional study was conducted using clustered sampling method. Xuanwu Hospital, a 3A grade hospital in Beijing. Nine hundred and fourteen medical staff aged over 40 years were sampled. Seven hundred and ninety-seven valid questionnaires were collected and used for further analyses. The sample included 94% of the Han population. The Copenhagen Psychosocial Questionnaire (COPSOQ) and the Suboptimal Health Status Questionnaires-25 were used to assess the psychosocial factors at work and suboptimal health status, respectively. CFA was conducted to establish the evaluating method of COPSOQ. A multivariate logistic regression model was used to estimate the relationship between suboptimal health status and stress-related psychosocial work factors among Chinese medical staff. There was a strong correlation among the five dimensions of COPSOQ based on the first-order factor model. Then, we established two second-order factors including negative and positive psychosocial work stress factors to evaluate psychosocial factors at work, and the second-order factor model fit well. The high score in negative (OR (95% CI)=1.47 (1.34 to 1.62), Pwork factors increased and decreased the risk of suboptimal health, respectively. This relationship remained statistically significant after adjusting for confounders and when using different cut-offs of suboptimal health status. Among medical staff, the second-order factor model was a suitable method to evaluate the COPSOQ. The negative and positive psychosocial work stress factors might be the risk and protective factors of suboptimal health, respectively. Moreover, negative psychosocial work stress was the most associated
Winkielman, Piotr; Gogolushko, Yekaterina
Affective stimuli can influence immediate reactions as well as spontaneous behaviors. Much evidence for such influence comes from studies of facial expressions. However, it is unclear whether these effects hold for other affective stimuli, and how the amount of stimulus processing changes the nature of the influence. This paper addresses these issues by comparing the influence on consumption behaviors of emotional pictures and valence-matched words presented at suboptimal and supraliminal durations. In Experiment 1, both suboptimal and supraliminal emotional facial expressions influenced consumption in an affect-congruent, assimilative way. In Experiment 2, pictures of both high- and low-frequency emotional objects congruently influenced consumption. In comparison, words tended to produce incongruent effects. We discuss these findings in light of privileged access theories, which hold that pictures better convey affective meaning than words, and embodiment theories, which hold that pictures better elicit somatosensory and motor responses. PMID:29434556
Aschemann-Witzel, Jessica; Jensen, Jacob Haagen; Jensen, Mette Hyldetoft; Kulikovskaja, Viktorija
To combat food waste, supermarkets offer food items at a reduced price in-store when they are close to the expiration date or perceived as suboptimal. It is yet unknown, however, which considerations consumers engage in when deciding about the offer, and whether focusing particularly on the price during food purchase might be related to greater food waste at home. Knowledge about both the consumers' food purchase process for these price-reduced foods and the potential wastage of price-focused consumers can contribute to the assessment of whether or not offering suboptimal food at reduced prices in-store actually reduces food waste across the supply chain. We explore these questions in a mixed-method study including 16 qualitative accompanied shopping interviews and a quantitative online experimental survey with 848 consumers in Denmark. The interviews reveal that the consumers interviewed assess their ability to consume the price-reduced suboptimal food at home already while in the store. Consumers consider the relation between product-related factors of package unit, expiration date, and product quality, in interaction with household-related factors of freezing/storing, household size/demand, and possible meal/cooking. The survey shows that consumers who are more price-focused report lower food waste levels and lower tendency to choose the optimal food item first at home, than those who are not emphasizing the price-quality relation or do not search for price offers to the same extent. Higher age and high education also played a role, and the price-focus is lower in high-income groups and among single households. The findings allow deriving recommendations for retailers and policy makers to support both the marketability and the subsequent actual consumption of price-reduced suboptimal food, but they also raise questions for further research of this underexplored area. Copyright © 2017 Elsevier Ltd. All rights reserved.
Full Text Available Schizophrenia is closely associated with cardiovascular risk factors which are consequently attributable to the development of chronic kidney disease and end-stage renal disease (ESRD. However, no study has been conducted to examine ESRD-related epidemiology and quality of care before starting dialysis for patients with schizophrenia. By using nationwide health insurance databases, we identified 54,361 ESRD-free patients with schizophrenia and their age-/gender-matched subjects without schizophrenia for this retrospective cohort study (the schizophrenia cohort. We also identified a cohort of 1,244 adult dialysis patients with and without schizophrenia (1:3 to compare quality of renal care before dialysis and outcomes (the dialysis cohort. Cox proportional hazard models were used to estimate the hazard ratio (HR for dialysis and death. Odds ratio (OR derived from logistic regression models were used to delineate quality of pre-dialysis renal care. Compared to general population, patients with schizophrenia were less likely to develop ESRD (HR = 0.6; 95% CI 0.4-0.8, but had a higher risk for death (HR = 1.2; 95% CI, 1.1-1.3. Patients with schizophrenia at the pre-ESRD stage received suboptimal pre-dialysis renal care; for example, they were less likely to visit nephrologists (OR = 0.6; 95% CI, 0.4-0.8 and received fewer erythropoietin prescriptions (OR = 0.7; 95% CI, 0.6-0.9. But they had a higher risk of hospitalization in the first year after starting dialysis (OR = 1.4; 95% CI, 1.0-1.8, P < .05. Patients with schizophrenia undertaking dialysis had higher risk for mortality than the general ESRD patients. A closer collaboration between psychiatrists and nephrologists or internists to minimize the gaps in quality of general care is recommended.
Cunningham, Paul J; Shahan, Timothy A
Suboptimal choice refers to preference for an alternative offering a low probability of food (suboptimal alternative) over an alternative offering a higher probability of food (optimal alternative). Numerous studies have found that stimuli signaling probabilistic food play a critical role in the development and maintenance of suboptimal choice. However, there is still much debate about how to characterize how these stimuli influence suboptimal choice. There is substantial evidence that the temporal information conveyed by a food-predictive signal governs its function as both a Pavlovian conditioned stimulus and as an instrumental conditioned reinforcer. Thus, we explore the possibility that food-predictive signals influence suboptimal choice via the temporal information they convey. Application of this temporal information-theoretic approach to suboptimal choice provides a formal, quantitative framework that describes how food-predictive signals influence suboptimal choice in a manner consistent with related phenomena in Pavlovian conditioning and conditioned reinforcement. Our reanalysis of previous data on suboptimal choice suggests that, generally speaking, preference in the suboptimal choice procedure tracks relative temporal information conveyed by food-predictive signals for the suboptimal and optimal alternatives. The model suggests that suboptimal choice develops when the food-predictive signal for the suboptimal alternative conveys more temporal information than that for the optimal alternative. Finally, incorporating a role for competition between temporal information provided by food-predictive signals and relative primary reinforcement rate provides a reasonable account of existing data on suboptimal choice. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Andersen, Elizabeth A; Spiers, Jude
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Care Aides' Relational Practices and Caring Contributions" found on pages 24-30, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until October 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Define the application of Swanson's Middle Range Theory of Caring in care aides' relational care practices for nursing home
Full Text Available BACKGROUND: New evidence shows high prevalence of vitamin D deficiency in many countries and some studies suggest a possible link between vitamin D status and allergic diseases. The objectives of this study were to determine the prevalence of suboptimal vitamin D status in a population sample of Asian children and to investigate the relationship of vitamin D status with allergic diseases and atopy. METHODS: Children aged 5-18 years (N = 1315 in the Prediction of Allergies in Taiwanese CHildren (PATCH study were evaluated using questionnaires, anthropometric measurements, and serum levels of 25-hydroxyvitamin D [25(OHD] and total and specific immunoglobulin E (IgE. RESULTS: The mean concentration of serum 25(OHD was 20.4 ng/mL (SD: 7.1 ng/mL. Vitamin D deficiency (defined as serum 25(OHD0.05. CONCLUSIONS: Low serum 25(OHD levels are remarkably common in this population sample of Asian children, suggesting that millions of children living in Taiwan may have suboptimal levels of vitamin D, which should be a matter of public health concern. Our results provides epidemiological evidence against the association of vitamin D status with various allergic diseases and atopy in Asian children.
Vasconcelos, Marco; Machado, Armando; Pandeirada, Josefa N S
Researchers have unraveled multiple cases in which behavior deviates from rationality principles. We propose that such deviations are valuable tools to understand the adaptive significance of the underpinning mechanisms. To illustrate, we discuss in detail an experimental protocol in which animals systematically incur substantial foraging losses by preferring a lean but informative option over a rich but non-informative one. To understand how adaptive mechanisms may fail to maximize food intake, we review a model inspired by optimal foraging principles that reconciles sub-optimal choice with the view that current behavioral mechanisms were pruned by the optimizing action of natural selection. To move beyond retrospective speculation, we then review critical tests of the model, regarding both its assumptions and its (sometimes counterintuitive) predictions, all of which have been upheld. The overall contention is that (a) known mechanisms can be used to develop better ultimate accounts and that (b) to understand why mechanisms that generate suboptimal behavior evolved, we need to consider their adaptive value in the animal's characteristic ecology. Copyright © 2018 Elsevier B.V. All rights reserved.
Scholten, A C; Haagsma, J A; Andriessen, T M J C; Vos, P E; Steyerberg, E W; van Beeck, E F; Polinder, S
The Glasgow Outcome Scale Extended (GOSE) is the established functional outcome scale to assess disability following traumatic brain injury (TBI), however does not capture the patient's subjective perspective. Health-related quality of life (HRQL) does capture the individual's perception of disability after TBI, and has therefore been recognized as an important outcome in TBI. In contrast to GOSE, HRQL enables comparison of health outcome across various disease states and with healthy individuals. We aimed to assess functional outcome, HRQL, recovery, and predictors of 6 and 12-month outcome in a comprehensive sample of patients with mild, moderate or severe TBI, and to examine the relationship between functional impairment (GOSE) and HRQL. A prospective cohort study was conducted among a sample of 2066 adult TBI patients who attended the emergency department (ED). GOSE was determined through questionnaires or structured interviews. Questionnaires 6 and 12 months after ED treatment included socio-demographic information and HRQL measured with Short-Form Health Survey (SF-36; reflecting physical, mental and social functioning) and Perceived Quality of Life Scale (PQoL; measuring degree of satisfaction with functioning). 996 TBI survivors with mild, moderate or severe TBI completed the 6-month questionnaire. Functional outcome and HRQL after moderate or severe TBI was significantly lower than after mild TBI. Patients with moderate TBI showed greatest improvement. After one year, the mild TBI group reached outcomes comparable to population norms. TBI of all severities highly affected SF-36 domains physical and social functioning, and physical and emotional role functioning. GOSE scores were highly related to all SF-36 domains and PQoL scores. Female gender, older age, co-morbidity and high ISS were strongest independent predictors of decreased HRQL at 6 and 12 months after TBI. HRQL and recovery patterns differ for mild, moderate and severe TBI. This study indicates
Carlijn eVan Den Boomen
Full Text Available Both categorization and segmentation processes play a crucial role in face perception. However, the functional relation between these subprocesses is currently unclear. The present study investigates the temporal relation between segmentation-related and category-selective responses in the brain, using electroencephalography (EEG. Surface segmentation and category content were both manipulated using texture-defined objects, including faces. This allowed us to study brain activity related to segmentation and to categorization. In the main experiment, participants viewed texture-defined objects for a duration of 800 ms. EEG results revealed that segmentation-related responses precede category-selective responses. Three additional experiments revealed that the presence and timing of categorization depends on stimulus properties and presentation duration. Photographic objects were presented for a long and short (92 ms duration and evoked fast category-selective responses in both cases. On the other hand, presentation of texture-defined objects for a short duration only evoked segmentation-related but no category-selective responses. Category-selective responses were much slower when evoked by texture-defined than by photographic objects. We suggest that in case of categorization of objects under suboptimal conditions, such as when low-level stimulus properties are not sufficient for fast object categorization, segmentation facilitates the slower categorization process.
Van Den Boomen, Carlijn; Fahrenfort, Johannes J; Snijders, Tineke M; Kemner, Chantal
Both categorization and segmentation processes play a crucial role in face perception. However, the functional relation between these subprocesses is currently unclear. The present study investigates the temporal relation between segmentation-related and category-selective responses in the brain, using electroencephalography (EEG). Surface segmentation and category content were both manipulated using texture-defined objects, including faces. This allowed us to study brain activity related to segmentation and to categorization. In the main experiment, participants viewed texture-defined objects for a duration of 800 ms. EEG results revealed that segmentation-related responses precede category-selective responses. Three additional experiments revealed that the presence and timing of categorization depends on stimulus properties and presentation duration. Photographic objects were presented for a long and short (92 ms) duration and evoked fast category-selective responses in both cases. On the other hand, presentation of texture-defined objects for a short duration only evoked segmentation-related but no category-selective responses. Category-selective responses were much slower when evoked by texture-defined than by photographic objects. We suggest that in case of categorization of objects under suboptimal conditions, such as when low-level stimulus properties are not sufficient for fast object categorization, segmentation facilitates the slower categorization process.
Beukenhorst, A. L.; Arts, D. L.; Lucassen, W.; Jager, K. J.; van der Veer, S. N.
Guidelines provide recommendations for antithrombotic treatment to prevent stroke in people with atrial fibrillation, but oral anticoagulant prescriptions in Dutch primary care are often discordant with these recommendations. Suboptimal guideline features (i.e. format and content) have been
Zentall, Thomas R
When humans engage in commercial (totally probabilistic) gambling they are making suboptimal choices because the return is generally less than the investment. This review (a) examines the literature on pigeon suboptimal choice, (b) describes the conditions under which it occurs, (c) identifies the mechanisms that appear to be responsible for the effect, and (d) suggests that similar processes may be able to account for analogous suboptimal choice when humans engage in commercial gambling. Pigeons show suboptimal choice when they choose between 1 alternative that 20% of the time provides them with a signal that they will always get fed or 80% of the time with a signal that they will not get fed (overall 20% reinforcement) and a second alternative that 100% of the time provides them with a signal that they will get fed 50% of the time (overall 50% reinforcement). The pigeons' strong preference for the suboptimal choice was investigated in a series of experiments that found the preference for the suboptimal alternative was determined by the value of the signal that predicted reinforcement, rather its frequency and that the frequency of the signal that predicted nonreinforcement had little effect on the suboptimal choice. Paradoxically, this account makes the prediction that pigeons will be indifferent between an alternative that 50% of the time provides a fully predictive stimulus for reinforcement and an alternative that 100% of the time provides a fully predictive stimulus for reinforcement. The similarities and differences of this suboptimal choice task to human gambling are discussed. (c) 2016 APA, all rights reserved).
Soley-Bori, Marina; Stefos, Theodore; Burgess, James F; Benzer, Justin K
Quality of care worries and rising costs have resulted in a widespread interest in enhancing the efficiency of health care delivery. One area of increasing interest is in promoting teamwork as a way of coordinating efforts to reduce costs and improve quality, and identifying the characteristics of the work environment that support teamwork. Relational climate is a measure of the work environment that captures shared employee perceptions of teamwork, conflict resolution, and diversity acceptance. Previous research has found a positive association between relational climate and quality of care, yet its relationship with costs remains unexplored. We examined the influence of primary care relational climate on health care costs incurred by diabetic patients at the U.S. Department of Veterans Affairs between 2008 and 2012. We found that better relational climate is significantly related to lower costs. Clinics with the strongest relational climate saved $334 in outpatient costs per patient compared with facilities with the weakest score in 2010. The total outpatient cost saving if all clinics achieved the top 5% relational climate score was $20 million. Relational climate may contribute to lower costs by enhancing diabetic treatment work processes, especially in outpatient settings.
Dalgas, Karina Märcher; Olwig, Karen Fog
An increasing number of young women from the Global South have become au pairs in the Global North since the turn of the millennium. Through ethnographic analysis of three cases of au pairing in Denmark, involving Filipina and Caribbean women, this article discusses the nature of the local as well...... as transnational family relations in which these women are embedded as au pairs, and the opportunities and restraints that they present. We use anthropological theory to conceptualize family and kinship in terms of notions and practices of relatedness. This offers a useful framework for elucidating the different...
Jensen, Bjarne Astrup; Nielsen, Jørgen Aase
that significant losses can arise when investors are diverse in their risk attitude. We also show that an investor with a low degree of risk aversion, like the logarithmic or the square root investor, often applied in portfolio choice models, can either inflict or be subject to severe losses when being forced...... two sources of suboptimal investment decisions as seen from each of the two investors individually. One is the suboptimal choice of portfolio, the other is the forced linear sharing rule. We measure the combined consequence for each investor by their respective loss in wealth equivalent. We show...
Difilippo, D. J.
In designing a suboptimal Kalman filter, the designer must decide how to simplify the system error model without causing the filter estimation errors to increase to unacceptable levels. Deletion of certain error states and decoupling of error state dynamics are the two principal model simplifications that are commonly used in suboptimal filter design. For the most part, the decisions as to which error states can be deleted or decoupled are based on the designer's understanding of the physics of the particular system. Consequently, the details of a suboptimal design are usually unique to the specific application. In this paper, the process of designing a suboptimal Kalman filter is illustrated for the case of an airborne transfer-of-alignment (TOA) system used for synthetic aperture radar (SAR) motion compensation. In this application, the filter must continuously transfer the alignment of an onboard Doppler-damped master inertial navigation system (INS) to a strapdown navigator that processes information from a less accurate inertial measurement unit (IMU) mounted on the radar antenna. The IMU is used to measure spurious antenna motion during the SAR imaging interval, so that compensating phase corrections can be computed and applied to the radar returns, thereby presenting image degradation that would otherwise result from such motions. The principles of SAR are described in many references, for instance. The primary function of the TOA Kalman filter in a SAR motion compensation system is to control strapdown navigator attitude errors, and to a less degree, velocity and heading errors. Unlike a classical navigation application, absolute positional accuracy is not important. The motion compensation requirements for SAR imaging are discussed in some detail. This TOA application is particularly appropriate as a vehicle for discussing suboptimal filter design, because the system contains features that can be exploited to allow both deletion and decoupling of error
Schwartenbeck, Philipp; FitzGerald, Thomas H.B.; Mathys, Christoph; Dolan, Ray; Wurst, Friedrich; Kronbichler, Martin; Friston, Karl
When casting behaviour as active (Bayesian) inference, optimal inference is defined with respect to an agent’s beliefs – based on its generative model of the world. This contrasts with normative accounts of choice behaviour, in which optimal actions are considered in relation to the true structure of the environment – as opposed to the agent’s beliefs about worldly states (or the task). This distinction shifts an understanding of suboptimal or pathological behaviour away from aberrant inference as such, to understanding the prior beliefs of a subject that cause them to behave less ‘optimally’ than our prior beliefs suggest they should behave. Put simply, suboptimal or pathological behaviour does not speak against understanding behaviour in terms of (Bayes optimal) inference, but rather calls for a more refined understanding of the subject’s generative model upon which their (optimal) Bayesian inference is based. Here, we discuss this fundamental distinction and its implications for understanding optimality, bounded rationality and pathological (choice) behaviour. We illustrate our argument using addictive choice behaviour in a recently described ‘limited offer’ task. Our simulations of pathological choices and addictive behaviour also generate some clear hypotheses, which we hope to pursue in ongoing empirical work. PMID:25561321
Tong, Xiaohong; Tang, Chao
Autonomous Underwater Vehicle (AUV) research focused on tracking and positioning, precise guidance and return to dock and other fields. The robotic fish of AUV has become a hot application in intelligent education, civil and military etc. In nonlinear tracking analysis of robotic fish, which was found that the interval Kalman filter algorithm contains all possible filter results, but the range is wide, relatively conservative, and the interval data vector is uncertain before implementation. This paper proposes a ptimization algorithm of suboptimal interval Kalman filter. Suboptimal interval Kalman filter scheme used the interval inverse matrix with its worst inverse instead, is more approximate nonlinear state equation and measurement equation than the standard interval Kalman filter, increases the accuracy of the nominal dynamic system model, improves the speed and precision of tracking system. Monte-Carlo simulation results show that the optimal trajectory of sub optimal interval Kalman filter algorithm is better than that of the interval Kalman filter method and the standard method of the filter.
Aaron P Smith
Full Text Available Pigeons have shown suboptimal gambling-like behavior when preferring a stimulus that infrequently signals reliable reinforcement over alternatives that provide greater reinforcement overall. As a mechanism for this behavior, recent research proposed that the stimulus value of alternatives with more reliable signals for reinforcement will be preferred relatively independently of their frequencies. The present study tested this hypothesis using a simplified design of a Discriminative alternative that, 50% of the time, led to either a signal for 100% reinforcement or a blackout period indicative of 0% reinforcement against a Nondiscriminative alternative that always led to a signal that predicted 50% reinforcement. Pigeons showed a strong preference for the Discriminative alternative that remained despite reducing the frequency of the signal for reinforcement in subsequent phases to 25% and then 12.5%. In Experiment 2, using the original design of Experiment 1, the stimulus following choice of the Nondiscriminative alternative was increased to 75% and then to 100%. Results showed that preference for the Discriminative alternative decreased only when the signals for reinforcement for the two alternatives predicted the same probability of reinforcement. The ability of several models to predict this behavior are discussed, but the terminal link stimulus value offers the most parsimonious account of this suboptimal behavior.
Tuominen, Tiina; Fuglsang, Lars; Hasu, Mervi
In this paper, we aim to understand how elderly care work is changing alongside the introduction of new co-creative frameworks and practices. The ideas of value co-creation and service co-production are expanding rapidly to new service areas also in the public sector. The elderly care context may...
.001. Conclusion: Suboptimal glycemic control was highly prevalent in this study population with an association to metformin monotherapy and insulin therapy. Strategies aimed at improving glycemic control in diabetes care in Uganda should be enhanced. Keywords: suboptimal glycemic control, frequency, predictors, Africa, Uganda
Full Text Available Abstract Background Energy and Zinc (Zn deficiencies have been associated with nutritional related growth retardation as well as growth hormone (GH resistance. In this study, the relationship between suboptimal energy and/or Zn intake and growth in rats and their response to immunoreactive exogenous recombinant human GH (GHi, was determined. Results Rats treated with GHi and fed ad-libitum energy and Zn (100/100 had increased IGFBP-3 (p Conclusion These results suggest that GHi enhances weight gain in rats with suboptimal energy and Zn intake but does not modify energy expenditure or physical activity index. Suboptimal Zn intake did not exacerbate the reduced growth or decrease in energy expenditure observed with energy restriction.
Augustussen, Mikaela; Hounsgaard, Lise; Pedersen, Michael Lynge
Palliative cancer care in Greenland is provided by health professionals at local level, the national Queen Ingrid's Hospital and at Rigshospitalet in Denmark. To improve and develop care for relatives of patients with advanced cancer, we conducted a mixed method study examining relatives' level...... of satisfaction with care and treatment and their current main concerns. The aim was to investigate relatives' level of satisfaction with advanced cancer care and bring to light their current main concerns. The FAMCARE-20 questionnaire was translated to Greenlandic and pilot tested. The questionnaire...... (66%) and relatives were the most dissatisfied with the lack of inclusion in decision making related to treatment and care (71%) and the length of time required to diagnose cancer (70%). Responses to the open-ended questions revealed that relatives faced challenges in gaining access to information...
Van Den Boomen, Carlijn; Fahrenfort, Johannes J; Snijders, Tineke M; Kemner, Chantal
Both categorization and segmentation processes play a crucial role in face perception. However, the functional relation between these subprocesses is currently unclear. The present study investigates the temporal relation between segmentation-related and category-selective responses in the brain,
Ven, G. van de; Draskovic, I.; Adang, E.M.M.; Donders, R.; Post, A.; Zuidema, S.U.; Koopmans, R.T.C.M.; Vernooij-Dassen, M.J.F.J.
BACKGROUND: The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the
Acerbi, Luigi; Vijayakumar, Sethu; Wolpert, Daniel M.
Humans have been shown to combine noisy sensory information with previous experience (priors), in qualitative and sometimes quantitative agreement with the statistically-optimal predictions of Bayesian integration. However, when the prior distribution becomes more complex than a simple Gaussian, such as skewed or bimodal, training takes much longer and performance appears suboptimal. It is unclear whether such suboptimality arises from an imprecise internal representation of the complex prior, or from additional constraints in performing probabilistic computations on complex distributions, even when accurately represented. Here we probe the sources of suboptimality in probabilistic inference using a novel estimation task in which subjects are exposed to an explicitly provided distribution, thereby removing the need to remember the prior. Subjects had to estimate the location of a target given a noisy cue and a visual representation of the prior probability density over locations, which changed on each trial. Different classes of priors were examined (Gaussian, unimodal, bimodal). Subjects' performance was in qualitative agreement with the predictions of Bayesian Decision Theory although generally suboptimal. The degree of suboptimality was modulated by statistical features of the priors but was largely independent of the class of the prior and level of noise in the cue, suggesting that suboptimality in dealing with complex statistical features, such as bimodality, may be due to a problem of acquiring the priors rather than computing with them. We performed a factorial model comparison across a large set of Bayesian observer models to identify additional sources of noise and suboptimality. Our analysis rejects several models of stochastic behavior, including probability matching and sample-averaging strategies. Instead we show that subjects' response variability was mainly driven by a combination of a noisy estimation of the parameters of the priors, and by
Full Text Available Humans have been shown to combine noisy sensory information with previous experience (priors, in qualitative and sometimes quantitative agreement with the statistically-optimal predictions of Bayesian integration. However, when the prior distribution becomes more complex than a simple Gaussian, such as skewed or bimodal, training takes much longer and performance appears suboptimal. It is unclear whether such suboptimality arises from an imprecise internal representation of the complex prior, or from additional constraints in performing probabilistic computations on complex distributions, even when accurately represented. Here we probe the sources of suboptimality in probabilistic inference using a novel estimation task in which subjects are exposed to an explicitly provided distribution, thereby removing the need to remember the prior. Subjects had to estimate the location of a target given a noisy cue and a visual representation of the prior probability density over locations, which changed on each trial. Different classes of priors were examined (Gaussian, unimodal, bimodal. Subjects' performance was in qualitative agreement with the predictions of Bayesian Decision Theory although generally suboptimal. The degree of suboptimality was modulated by statistical features of the priors but was largely independent of the class of the prior and level of noise in the cue, suggesting that suboptimality in dealing with complex statistical features, such as bimodality, may be due to a problem of acquiring the priors rather than computing with them. We performed a factorial model comparison across a large set of Bayesian observer models to identify additional sources of noise and suboptimality. Our analysis rejects several models of stochastic behavior, including probability matching and sample-averaging strategies. Instead we show that subjects' response variability was mainly driven by a combination of a noisy estimation of the parameters of the
Ray, Marilyn A; Turkel, Marian C
In the culture of health care, nurses are challenged to understand their values and beliefs as humanistic within complex technical and economically driven bureaucratic systems. This article outlines the language of social justice and human rights and the advance of a Theory of Relational Caring Complexity, which offers insights into caring as emancipatory nursing praxis. Recommendations provide knowledge of the struggle to balance economics, technology, and caring. As nurses practice from a value-driven, philosophical, and ethical social justice framework, they will find "their voice" and realize the full potential that the power of caring has on patient and organizational outcomes.
Sinja Alexandra Ernst
Full Text Available Objective. To identify care-related and maternal risk factors for the antenatal nondetection of IUGR. Methods. In this hospital-based case-control study we compared antenatally undetected IUGR neonates (cases to detected IUGR neonates (controls. Data were collected using newborn documentation sheets and standardized personal interviews with the mothers. We calculated antenatal detection rates and used uni- and multivariable logistic regression models to assess the association of antenatal nondetection of IUGR and maternal and care-related factors. Results. A total of 161 neonates from three hospitals were included in the study. Suboptimal fetal growth was identified antenatally in n=77 pregnancies while in n=84 it was not detected antenatally (antenatal detection rate: 47.8%. Severity of IUGR, maternal complications, and a Doppler examination during the course of pregnancy were associated with IUGR detection. We did not find statistically significant differences regarding parental socioeconomic status and maternal migration background. Conclusions. In our study, about half of all pregnancies affected by suboptimal growth remained undetected. Future in-depth studies with larger study populations should further examine factors that could increase antenatal detection rates for IUGR.
Full Text Available Jose Manuel Montes1, Jorge Maurino2, Consuelo de Dios3, Esteban Medina21Department of Psychiatry, Hospital Universitario del Sureste, 2AstraZeneca Medical Department, 3Department of Psychiatry, Hospital Universitario La Paz, Madrid, SpainBackground: The primary aim of this study was to assess drug treatment adherence in patients with bipolar disorder and to identify factors associated with adherence. The secondary aim was to analyze the impact of suboptimal adherence on clinical and functional outcomes.Methods: A cross-sectional study was conducted in a sample of outpatients receiving an oral antipsychotic drug. Medication adherence was assessed combining the 10-item Drug Attitude Inventory, the Morisky Green Adherence Questionnaire, and the Compliance Rating Scale. Logistic regression was used to determine significant variables associated with suboptimal adherence to medication.Results: Three hundred and three patients were enrolled into the study. The mean age was 45.9 ± 12.8 years, and 59.7% were females. Sixty-nine percent of patients showed suboptimal adherence. Disease severity and functioning were significantly worse in the suboptimal group than in the adherent group. Multivariate analysis showed depressive polarity of the last acute episode, presence of subsyndromal symptoms, and substance abuse/dependence to be significantly associated with suboptimal treatment adherence (odds ratios 3.41, 2.13, and 1.95, respectively.Conclusion: A high prevalence of nonadherence was found in an outpatient sample with bipolar disorder. Identification of factors related to treatment adherence would give clinicians the opportunity to select more adequately patients who are eligible for potential adherence-focused interventions.Keywords: bipolar disorder, treatment adherence, functioning, polarity, subsyndromal symptoms
Choi, Jung Il; Sung, Hyung Jin; Xu, Chun Xiao
A suboptimal control law in turbulent pipe flow is derived and tested. Two sensing variables ∂ρ/∂θ / w and ∂ν θ /∂r / w are applied with two actuations φ θ and φ γ . To test the suboptimal control law, direct numerical simulations of turbulent pipe flow at Re τ =150 are performed. When the control law is applied, a 13∼23% drag reduction is achieved. The most effective drag reduction is made at the pair of ∂υ θ /∂r / w and φ γ . An impenetrable virtual wall concept is useful for analyzing the near-wall suction and blowing. The virtual wall concept is useful for analyzing the near-wall behavior of the controlled flow. Comparison of the present suboptimal control with that of turbulent channel flow reveals that the curvature effect is insignificant
Full Text Available William Lumu,1 Leaticia Kampiire,2 George Patrick Akabwai,3 Daniel Ssekikubo Kiggundu,4 Davis Kibirige5 1Department of Medicine and Diabetes/Endocrine Unit, Mengo Hospital, 2Infectious Disease Research Collaboration, 3Baylor College of Medicine Children’s Foundation, 4Nephrology Unit, Mulago National Referral and Teaching Hospital, 5Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda Background: Hypertension is one of the recognized risk factors of cardiovascular diseases in adult diabetic patients. High prevalence of suboptimal blood pressure (BP control has been well documented in the majority of studies assessing BP control in diabetic patients in sub-Saharan Africa. In Uganda, there is a dearth of similar studies. This study evaluated the prevalence and correlates of suboptimal BP control in an adult diabetic population in Uganda.Patients and methods: This was a cross-sectional study that enrolled 425 eligible ambulatory adult diabetic patients attending three urban diabetic outpatient clinics over 11 months. Data about their sociodemographic characteristics and clinical history were collected using pre-tested questionnaires. Suboptimal BP control was defined according to the 2015 American Diabetes Association standards of diabetes care guideline as BP levels ≥140/90 mmHg.Results: The mean age of the study participants was 52.2±14.4 years, with the majority being females (283, 66.9%. Suboptimal BP control was documented in 192 (45.3% study participants and was independently associated with the study site (private hospitals; odds ratio 2.01, 95% confidence interval 1.18–3.43, P=0.01 and use of statin therapy (odds ratio 0.5, 95% confidence interval 0.26–0.96, P=0.037.Conclusion: Suboptimal BP control was highly prevalent in this study population. Strategies to improve optimal BP control, especially in the private hospitals, and the use of statin therapy should be encouraged in adult diabetic patients
Maeda, Yasuko; Lundby, Lilli; Buntzen, Steen
Sacral nerve stimulation is an emerging treatment for patients with severe constipation. There has been no substantial report to date on suboptimal outcomes and complications. We report our experience of more than 6 years by focusing on incidents and the management of reportable events.......Sacral nerve stimulation is an emerging treatment for patients with severe constipation. There has been no substantial report to date on suboptimal outcomes and complications. We report our experience of more than 6 years by focusing on incidents and the management of reportable events....
Augustussen, Mikaela; Hounsgaard, Lise; Pedersen, Michael Lynge
from health professionals. They experienced a lack of security, worries about the future and a lack of support at home. The study showed a substantial level of dissatisfaction among relatives of patients with advanced cancer. We strongly recommend a focus on psychosocial care, more access......Palliative cancer care in Greenland is provided by health professionals at local level, the national Queen Ingrid's Hospital and at Rigshospitalet in Denmark. To improve and develop care for relatives of patients with advanced cancer, we conducted a mixed method study examining relatives' level...... was supplemented by open-ended questions about relative's current main concerns and analyzed with a phenomenological hermeneutical approach. Greenlandic patients with advanced cancer who were previously participating in a prospective study were asked if their closest adult relative would participate in the study...
da Silva, Andréa Tenório Correia; Lopes, Claudia de Souza; Susser, Ezra; Menezes, Paulo Rossi
To identify work-related factors associated with depressive symptoms and probable major depression in primary care teams. Cross-sectional study among primary care teams (community health workers, nursing assistants, nurses, and physicians) in the city of São Paulo, Brazil (2011-2012; n = 2940), to assess depressive symptoms and probable major depression and their associations with job strain and other work-related conditions. Community health workers presented higher prevalence of probable major depression (18%) than other primary care workers. Higher odds ratios for depressive symptoms or probable major depression were associated with longer duration of employment in primary care; having a passive, active, or high-strain job; lack of supervisor feedback regarding performance; and low social support from colleagues and supervisors. Observed levels of job-related depression can endanger the sustainability of primary care programs. Public Health implications. Strategies are needed to deliver care to primary care workers with depression, facilitating diagnosis and access to treatment, particularly in low- and middle-income countries. Preventive interventions can include training managers to provide feedback and creating strategies to increase job autonomy and social support at work.
Full Text Available With proactive dependent interviewing (PDI respondents are reminded of the answer they gave in the previous interview, before being asked about their current status. PDI is used in panel surveys to assist respondent recall and reduce spurious changes in responses over time. PDI may however provide scope for new errors if respondents falsely accept the previous information as still being an accurate description of their current situation. In this paper we use data from the German Labour Market and Social Security panel study, in which an error was made with the preload data for a PDI question about receipt of welfare benefit. The survey data were linked to individual administrative records on receipt of welfare benefit. A large proportion of respondents accepted the false preload. This behaviour seems mainly driven by the difficulty of the response task: respondents with a more complex history of receipt according to the records were more likely to confirm the false preload. Personality also seemed related to the probability of confirming. Predictors of satisficing, indicators of satisficing on other items in the survey, and characteristics of the survey and interviewer were not predictive of confirming the false preload.
This paper describes the approach of empirical ethics, a form of ethics that integrates non-positivist ethnographic empirical research and philosophy. Empirical ethics as it is discussed here builds on the 'empirical turn' in epistemology. It radicalizes the relational approach that care ethics introduced to think about care between people by drawing in relations between people and technologies as things people relate to. Empirical ethics studies care practices by analysing their intra-normativity, or the ways of living together the actors within these practices strive for or bring about as good practices. Different from care ethics, what care is and if it is good is not defined beforehand. A care practice may be contested by comparing it to alternative practices with different notions of good care. By contrasting practices as different ways of living together that are normatively oriented, suggestions for the best possible care may be argued for. Whether these suggestions will actually be put to practice is, however, again a relational question; new actors need to re-localize suggestions, to make them work in new practices and fit them in with local intra-normativities with their particular routines, material infrastructures, know-how and strivings.
Niesten, D.J.M.; Witter, D.J.; Bronkhorst, E.M.; Creugers, N.H.J.
OBJECTIVES: To assess, in older people with different levels of care-dependency 1) which frailty- and non-frailty related predisposing, enabling and need factors are associated with a) dental service use (DSU) frequency, b) changed DSU after the onset of care-dependency, c) brushing frequency, and
Giakoumaki, S G; Roussos, P; Zouraraki, C; Spanoudakis, E; Mavrikaki, M; Tsapakis, E M; Bitsios, P
Part of the variation in personality characteristics has been attributed to the child-parent interaction and sub-optimal parenting has been associated with psychiatric morbidity. In the present study, an extensive battery of personality scales (Trait Anxiety Inventory, Behavioural Inhibition/Activation System questionnaire, Eysenck Personality Questionnaire-Revised, Temperament and Character Inventory, Schizotypal Traits Questionnaire, Toronto Alexithymia Scale) and the Parental Bonding Instrument (PBI) were administered in 324 adult healthy males to elucidate the effects of parenting on personality configuration. Personality variables were analysed using Principal Component Analysis (PCA) and the factors "Schizotypy", "Anxiety", "Behavioural activation", "Novelty seeking" and "Reward dependence" were extracted. Associations between personality factors with PBI "care" and "overprotection" scores were examined with regression analyses. Subjects were divided into "parental style" groups and personality factors were subjected to categorical analyses. "Schizotypy" and "Anxiety" were significantly predicted by high maternal overprotection and low paternal care. In addition, the Affectionless control group (low care/high overprotection) had higher "Schizotypy" and "Anxiety" compared with the Optimal Parenting group (high care/low overprotection). These results further validate sub-optimal parenting as an important environmental exposure and extend our understanding on the mechanisms by which it increases risk for psychiatric morbidity. Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Similarly, not attending formal education, low birth order and lack of knowledge about exclusive breastfeeding were also negatively associated with exclusive breastfeeding practice. Conclusion: In this study, sub-optimal breast feeding was found to be high. Delayed initiation and non-exclusive breastfeeding practices were ...
B. Wierenga (Berend); H. Soethoudt (Han)
textabstractThis paper deals with sales promotions in the form of consumer price discounts in fast-moving consumer goods. First, we show analytically that suboptimality is to be expected with respect to the size of the consumer price discount. This is due to the separate decision making of the
Polenick, Courtney A; Leggett, Amanda N; Maust, Donovan T; Kales, Helen C
Medical care tasks are commonly provided by spouses caring for persons living with dementia (PLWDs). These tasks reflect complex care demands that may interfere with sleep, yet their implications for caregivers' sleep outcomes are unknown. The authors evaluated the association between caregivers' medical/nursing tasks (keeping track of medications; managing tasks such as ostomy care, intravenous lines, or blood testing; giving shots/injections; and caring for skin wounds/sores) and care-related sleep disturbances. A retrospective analysis of cross-sectional data from the 2011 National Health and Aging Trends Study and National Study of Caregiving was conducted. Spousal caregivers and PLWDs/proxies were interviewed by telephone at home. The U.S. sample included 104 community-dwelling spousal caregivers and PLWDs. Caregivers reported on their sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and sleep disturbances. PLWDs (or proxies) reported on their health conditions and sleep problems. Caregivers who performed a higher number of medical/nursing tasks reported significantly more frequent care-related sleep disturbances, controlling for sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and PLWDs' sleep problems and health conditions. Post hoc tests showed that wound care was independently associated with more frequent care-related sleep disturbances after accounting for the other medical/nursing tasks and covariates. Spousal caregivers of PLWDs who perform medical/nursing tasks may be at heightened risk for sleep disturbances and associated adverse health consequences. Interventions to promote the well-being of both care partners may benefit from directly addressing caregivers' needs and concerns about their provision of medical/nursing care. Copyright © 2018 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights
Lundstrøm, Louise Hyldborg; Johnsen, Anna Thit; Ross, Lone
Background. Cancer care usually involves several health professionals from different parts of the health care system. Often, the GP has an important role. Patients’ experiences of continuity and support may be related to characteristics of health care, disease or patients. Objectives. To investig......Background. Cancer care usually involves several health professionals from different parts of the health care system. Often, the GP has an important role. Patients’ experiences of continuity and support may be related to characteristics of health care, disease or patients. Objectives...... patients experienced suboptimal cross-sectorial cooperation and supportive care. Efforts to improve cancer care cooperation may focus on the possible supportive role of the...
Fishman, Jesse; Kalilani, Linda; Song, Yan; Swallow, Elyse; Wild, Imane
Unexpected breakthrough seizures resulting from suboptimal antiepileptic drug (AED) dosing during the titration period, as well as adverse events resulting from rapid AED titration, may influence the titration schedule and significantly increase health care resource use (HRU) and health care costs. To assess the relationship between AEDs, HRU, and costs during AED titration and maintenance. Practicing neurologists were recruited from a nationwide panel to provide up to 3 patient records each for this retrospective medical chart review. Patients with epilepsy who were aged ≥ 18 years and had initiated an AED between January 1, 2014, and January 1, 2016, were followed for 6 months from AED initiation. Titration duration was the time from AED initiation to the beginning of treatment maintenance as determined by the physician. Outcomes were epilepsy-specific HRU (hospitalizations, emergency department visits, outpatient visits, physician referral, laboratory testing/diagnostic imaging, and phone calls) and related costs that occurred during the titration or maintenance treatment periods. Of 811 patients, 156, 128, 125, 120, 114, 107, and 61 initiated the following AEDs: levetiracetam, lamotrigine, lacosamide, valproate, topiramate, carbamazepine, and phenytoin, respectively. Most patients (619/803 [77.1%] with complete AED data) received monotherapy. Baseline characteristics were similar across AEDs (mean [SD] age, 36.6 [14.4] years; 59.0% male). Kaplan-Meier estimates of titration duration ranged from 3.3 weeks (phenytoin) to 8.1 weeks (lamotrigine). From titration to maintenance, the overall incidence of HRU per person-month decreased 54.5%-89.3% for each HRU measure except outpatient visits (24.6% decrease). Total epilepsy-related costs decreased from $80.48 to $42.77 per person-month, or 46.9% from titration to maintenance. AED titration periods had higher HRU rates and costs than AED maintenance, suggesting that use of AEDs with shorter titration requirements
Wang, Wei; Russell, Alyce; Yan, Yuxiang
The premise of disease-related phenotypes is the definition of the counterpart normality in medical sciences. Contrary to clinical practices that can be carefully planned according to clinical needs, heterogeneity and uncontrollability is the essence of humans in carrying out health studies. Full characterization of consistent phenotypes that define the general population is the basis to individual difference normalization in personalized medicine. Self-claimed normal status may not represent health because asymptomatic subjects may carry chronic diseases at their early stage, such as cancer, diabetes mellitus and atherosclerosis. Currently, treatments for non-communicable chronic diseases (NCD) are implemented after disease onset, which is a very much delayed approach from the perspective of predictive, preventive and personalized medicine (PPPM). A NCD pandemic will develop and be accompanied by increased global economic burden for healthcare systems throughout both developed and developing countries. This paper examples the characterization of the suboptimal health status (SHS) which represents a new PPPM challenge in a population with ambiguous health complaints such as general weakness, unexplained medical syndrome (UMS), chronic fatigue syndrome (CFS), myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS) and chronic fatigue immune dysfunction syndrome (CFIDS). We applied clinical informatic approaches and developed a questionnaire-suboptimal health status questionnaire-25 (SHSQ-25) for measuring SHS. The validity and reliability of this approach were evaluated in a small pilot study and then in a cross-sectional study of 3,405 participants in China. We found a correlation between SHS and systolic blood pressure, diastolic blood pressure, plasma glucose, total cholesterol and high-density lipoprotein (HDL) cholesterol among men, and a correlation between SHS and systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides
Krista J Siefried
Full Text Available Missing more than one tablet of contemporary antiretroviral therapy (ART per month increases the risk of virological failure. Recent studies evaluating a comprehensive range of potential risk factors for suboptimal adherence are not available for high-income settings.Adults on ART with undetectable viral load (UDVL were recruited into a national, multi-centre cohort, completing a comprehensive survey assessing demographics, socio-economic indicators, physical health, well-being, life stressors, social supports, HIV disclosure, HIV-related stigma and discrimination, healthcare access, ART regimen, adherence, side effects, costs and treatment beliefs. Baseline data were assessed, and suboptimal adherence was defined as self-reported missing ≥1 ART dose/month over the previous 3-months; associated factors were identified using bivariate and multivariate binary logistic regression.We assessed 522 participants (494 [94.5%] men, mean age = 50.8 years, median duration UDVL = 3.3 years [IQR = 1.2-6.8] at 17 sexual health, hospital, and general practice clinics across Australia. Seventy-eight participants (14.9% reported missing ≥1 dose/month over the previous three months, which was independently associated with: being Australian-born (AOR [adjusted odds ratio] = 2.4 [95%CI = 1.2-4.9], p = 0.014, not being in a relationship (AOR = 3.3 [95%CI = 1.5-7.3], p = 0.004, reaching the "Medicare safety net" (capping annual medical/pharmaceutical costs (AOR = 2.2 [95%CI = 1.1-4.5], p = 0.024, living in subsidised housing (AOR = 2.5 [95%CI = 1.0-6.2], p = 0.045, receiving home-care services (AOR = 4.4 [95%CI = 1.0-18.8], p = 0.046, HIV community/outreach services linkage (AOR = 2.4 [95%CI = 1.1-5.4], p = 0.033, and starting ART following self-request (AOR = 3.0 [95%CI = 1.3-7.0], p = 0.012.In this population, 15% reported recent suboptimal ART adherence at levels associated in prospective studies with subsequent virological failure, despite all having an
Jakobsen, Rita; Sellevold, Gerd Sylvi; Egede-Nissen, Veslemøy; Sørlie, Venke
A total of 71,000 people in Norway suffer from some form of dementia in 2013, of whom approximately 30,000 are in nursing homes. Several studies focus on the experiences of those who have close relatives and who are staying in a nursing home. Results show that a greater focus on cooperation between nursing staff and relatives is a central prerequisite for an increased level of care. Benefits of developing systematic collaboration practices include relief for nursing staff, less stress, and greater mutual understanding. Going through studies focusing on the experiences of nursing home patients' relatives, negative experiences are in the majority. In this study, relatives are invited to share positive experiences regarding the care of their loved ones; a slightly different perspective, in other words. The aim of the study is to investigate relatives of persons with dementia's experiences with quality care in nursing homes. The study is a part of a larger project called Hospice values in the care for persons with dementia and is based on a qualitative design where data are generated through narrative interviews. The chosen method of analysis is the phenomenological-hermeneutical method for the study of lived experiences. Participants and research context: Participants in the project were eight relatives of persons with dementia who were living in nursing homes, long-term residences. The sampling was targeted, enrolment happened through collective invitation. All relatives interested were included. Ethical considerations: The Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services approve the study. Findings show that relatives have certain expectations as to how their loved ones ought to be met and looked after at the nursing home. The results show that in those cases where the expectations were met, the relatives' experiences were associated with engagement, inclusion and a good atmosphere. When the expectations were not met, the relatives
Chari, Satyan R; McRae, Prue; Stewart, Matthew J; Webster, Joan; Fenn, Mary; Haines, Terry P
usage and choices have been explored in older people in the community and in residential care settings, there is little comparable data on acutely unwell older hospital patients. What does this paper add? This paper provides prevalence data on the use of footwear with suboptimal characteristics among ambulant older hospital patients, and identifies concurrent factors that may be relevant to patient footwear choices. What are the implications for practitioners? Pain, foot pathology and a desire to retain independence are important concerns for hospitalised patients and are likely to influence their choice of footwear used to ambulate with. Pragmatic team-based approaches that remain sensitive to key patient concerns may be more successful in optimising patient footwear usage than footwear education strategies alone.
...-related donations and health care-related taxes. 433.57 Section 433.57 Public Health CENTERS FOR MEDICARE... rules regarding revenues from provider-related donations and health care-related taxes. Effective... FFP, funds from provider-related donations and revenues generated by health care-related taxes...
Nöstlinger, Christiana; Rojas Castro, Daniela; Platteau, Tom; Dias, Sonia; Le Gall, Jean
This cross-sectional European study assessed self-reported HIV-related discrimination and its associated factors in health care settings. Socio-demographics, health status, support needs relating to sexual and reproductive health (SRH), and self-reported HIV-related discrimination were measured using an anonymous survey in a sample of 1549 people living with HIV from 14 countries. Thirty-two per cent of the participants had experienced HIV-related discrimination during the previous 3 years; almost half of them felt discriminated against by health care providers. For this type of discrimination, logistic regression analysis revealed significant associations with not being a migrant (OR: 2.0; IC 1.0-3.7; psex practices (OR: 1.8; IC 1.0-3.2; pgender had a protective effect (OR: 0.2; IC 0.0-0.9; pdiscrimination. Improving health care providers' communication skills, and fostering openness about SRH topics in HIV care could contribute to destigmatization of PLHIV.
This rule finalizes our proposal to delay enforcement of certain clarifications regarding standards for determining hold harmless arrangements in the final rule entitled, "Medicaid Program; Health Care-Related Taxes" from the expiration of a Congressional moratorium on enforcement from July 1, 2009 to June 30, 2010.
Mazandarani, Mehran; Pariz, Naser
This paper deals with sub-optimal control of a fuzzy linear dynamical system. The aim is to keep the state variables of the fuzzy linear dynamical system close to zero in an optimal manner. In the fuzzy dynamical system, the fuzzy derivative is considered as the granular derivative; and all the coefficients and initial conditions can be uncertain. The criterion for assessing the optimality is regarded as a granular integral whose integrand is a quadratic function of the state variables and control inputs. Using the relative-distance-measure (RDM) fuzzy interval arithmetic and calculus of variations, the optimal control law is presented as the fuzzy state variables feedback. Since the optimal feedback gains are obtained as fuzzy functions, they need to be defuzzified. This will result in the sub-optimal control law. This paper also sheds light on the restrictions imposed by the approaches which are based on fuzzy standard interval arithmetic (FSIA), and use strongly generalized Hukuhara and generalized Hukuhara differentiability concepts for obtaining the optimal control law. The granular eigenvalues notion is also defined. Using an RLC circuit mathematical model, it is shown that, due to their unnatural behavior in the modeling phenomenon, the FSIA-based approaches may obtain some eigenvalues sets that might be different from the inherent eigenvalues set of the fuzzy dynamical system. This is, however, not the case with the approach proposed in this study. The notions of granular controllability and granular stabilizability of the fuzzy linear dynamical system are also presented in this paper. Moreover, a sub-optimal control for regulating a Boeing 747 in longitudinal direction with uncertain initial conditions and parameters is gained. In addition, an uncertain suspension system of one of the four wheels of a bus is regulated using the sub-optimal control introduced in this paper. Copyright © 2018 ISA. Published by Elsevier Ltd. All rights reserved.
Tsuji, Masashi; Ogawa, Yuichi
We attempted to develop an effective control system that can successfully manage the nuclear steam supply (NSS) system of a PWR power plant in an operational mode requiring relatively small variations of power. A procedure is proposed for synthesizing control system that is a simple, yet practiced, suboptimal control system. The suboptimal control system is designed in two steps; application of the optimal control theory, based on the linear state-feedback control and the use of an approximate model-following method. This procedure can appreciably reduce the complexity of the structure of the controller by accepting a slight deviation from the optimality and by the use of the output-feedback control. This eliminates the engineering difficulty caused by an incompletely state-feedback that is sometimes encountered in practical applications of the optimal state-feedback control theory to complex large-scale dynamical systems. Digital simulations and graphical studies based on the Bode-diagram demonstrate the effectiveness of the suboptimal control, and the applicability of the proposed design method as well. (author)
Yıldız, Mehmet Kamil; Okan, İsmail; Nazik, Hasan; Bas, Gurhan; Alimoglu, Orhan; İlktac, Mehmet; Daldal, Emin; Sahin, Mustafa; Kuvat, Nuray; Ongen, Betugul
The fate of suboptimal anastomosis is unknown and early detection of anastomotic leakage after colon resection is crucial for the proper management of patients. Twenty-six rats were assigned to "Control", "Leakage" and "Suboptimal anastomosis" groups where they underwent either sham laparotomy, cecal ligation, and puncture or anastomosis with four sutures following colon resection, respectively. At the fifth hour and on the third and ninth days; peripheral blood and peritoneal washing samples through relaparotomy were obtained. The abdomen was inspected macroscopically for anastomotic healing. Polymerase chain reaction (PCR) with 16s rRNA and E.coli-specific primers were run on all samples along with aerobic and anaerobic cultures. The sensitivity and specificity of PCR on different bodily fluids with 16s rRNA and E.coli-specific primers were 100% and 78%, respectively. All samples of peritoneal washing fluids on the third and ninth days showed presence of bacteria in both PCR and culture. The inspection of the abdomen revealed signs of anastomotic leakage in eight rats (80%), whereas mortality related with anastomosis was detected in two (20%). Anastomotic leakage with suboptimal anastomosis after colon resection is high and the early detection is possible by running PCR on peritoneal samples as early as 72 hours.
Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. Research design and context: A case study was conducted in a professional development course ('learning circle') for home care nurses, including participant observations and focus groups. The theoretical notion of 'relational agency' and the moral concept of 'practices of responsibility' were used to conduct a narrative analysis on the nurses' stories about autonomy. Eight nurses, two coaches and two university lecturers who participated in the learning circle. Ethical considerations: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients' strengths and collaboration with patients and informal caregivers. On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together.
Fry, Margaret; MacGregor, Casimir; Ruperto, Kate; Jarrett, Kate; Wheeler, Janet; Fong, Jacqueline; Fetchet, Wendy
The Clinical Initiative Nurse (CIN) is a role that requires experienced emergency nurses to assess, initiate diagnostic tests, treat and manage a range of patient conditions. The CIN role is focused on the waiting room and to 'communicate the wait', initiate diagnostics or treatment and follow-up for waiting room patients. We aim to explore what emergency nurses' do in their extended practice role in observable everyday life in the emergency department (ED). The paper argues that compassionate caring is a core nursing skill that supports CIN interpersonal relations, despite the role's highly clinical nature. Sixteen non-participant observations were undertaken in three EDs in New South Wales, Australia. Nurses were eligible for inclusion if they had two years of emergency experience and had worked in the CIN role for more than one year. All CIN's that were observed were highly experienced with a minimum three year ED experience. The CIN observations revealed how compassionate caring was utilised by CIN's to quickly build a therapeutic relationship with patients and colleagues, and helped to facilitate core communication and interpersonal skills. While the CIN role was viewed as extended practice, the role relied heavily on compassionate care to support interpersonal relationships and to actualise extended practice care. The study supports the contribution made by emergency nurses and demonstrates how compassionate caring is central to nursing praxis. This paper also demonstrates that the CIN role utilises a complex mix between advanced clinical skills and compassion that supports interpersonal and therapeutic relationships. Further research is needed to understand how compassionate care can be optimised within nursing praxis and the duty of care between nurses and patients, nurses and other health care professionals so that future healthcare goals can be realised. Copyright © 2013 College of Emergency Nursing Australasia Ltd. All rights reserved.
Ciftcioglu, Oe.; Hoogenboom, J.E.; Dam, H. van
Anomaly detection for nuclear reactor surveillance and diagnosis is described. The residual noise obtained as a result of autoregressive (AR) modelling is essential to obtain high sensitivity for anomaly detection. By means of the method of hypothesis testing a suboptimal anomaly detection processor is devised for system surveillance and diagnosis. Experiments are carried out to investigate the performance of the processor, which is in particular of interest for on-line and real-time applications.
Symmank, Claudia; Zahn, Susann; Rohm, Harald
One reason for the significant amount of food that is wasted in developed countries is that consumers often expect visually suboptimal food as being less palatable. Using bananas as example, the objective of this study was to determine how appearance affects consumer overall liking, the rating of sensory attributes, purchase intention, and the intended use of bananas. The ripeness degree (RD) of the samples was adjusted to RD 5 (control) and RD 7 (more ripened, visually suboptimal). After preliminary experiments, a total of 233 participants were asked to judge their satisfaction with the intensity of sensory attributes that referred to flavor, taste, and texture using just-about-right scales. Subjects who received peeled samples were asked after tasting, whereas subjects who received unpeeled bananas judged expectation and, after peeling and tasting, perception. Expected overall liking and purchase intention were significantly lower for RD 7 bananas. Purchase intention was still significantly different between RD 5 and RD 7 after tasting, whereas no difference in overall liking was observed. Significant differences between RD 5 and RD 7 were observed when asking participants for their intended use of the bananas. Concerning the sensory attributes, penalty analysis revealed that only the firmness of the RD 7 bananas was still not just-about-right after tasting. The importance that consumers attribute to the shelf-life of food had a pronounced impact on purchase intention of bananas with different ripeness degree. In the case of suboptimal bananas, the results demonstrate a positive relationship between the sensory perception and overall liking and purchase intention. Convincing consumers that visually suboptimal food is still tasty is of high relevance for recommending different ways of communication. Copyright © 2017 Elsevier Ltd. All rights reserved.
Laude, Jennifer R; Pattison, Kristina F; Zentall, Thomas R
Hungry animals will often choose suboptimally by being attracted to reliable signals for food that occur infrequently (they gamble) over less reliable signals for food that occur more often. That is, pigeons prefer an option that 50 % of the time provides them with a reliable signal for the appearance of food but 50 % of the time provides them with a reliable signal for the absence of food (overall 50 % reinforcement) over an alternative that always provides them with a signal for the appearance of food 75 % of the time (overall 75 % reinforcement). The pigeons appear to choose impulsively for the possibility of obtaining the reliable signal for reinforcement. There is evidence that greater hunger is associated with greater impulsivity. We tested the hypothesis that if the pigeons were less hungry, they would be less impulsive and, thus, would choose more optimally (i.e., on the basis of the overall probability of reinforcement). We found that hungry pigeons choose the 50 % reinforcement alternative suboptimally but less hungry pigeons prefer the more optimal 75 % reinforcement. Paradoxically, pigeons that needed the food more received less of it. These findings have implications for how level of motivation may also affect human suboptimal choice (e.g., purchase of lottery tickets and playing slot machines).
Timon Cheng-Yi Liu
Full Text Available The global photobiomodulation (PBM on an organism was studied in terms of function-specific homeostasis (FSH and scale-free functional network in this paper. A function can be classified into a normal function in its FSH and a dysfunctional function far from its FSH. An FSH-specific stress (FSS disrupting an FSH can also be classified into a successful stress in its FSS-specific homeostasis (FSSH and a chronic stress far from its FSSH. The internal functions of an organism can be divided into essential, special nonessential, and general nonessential functions. Health may be defined as a state of an organism in which all the essential and special nonessential functions are normal or their stresses are successful. Suboptimal health may be defined as a state of a disease-free organism in which only some special nonessential functions are dysfunctional in comparison with its healthy state. Disease may be defined as a state of an organism which is not in both health and suboptimal health. The global PBM of health, suboptimal health, or disease suggested that the PBM may depend on the organism action.
Thiriet, L.; Deledicq, A.
First, the point of applying Dynamic Programming to optimization and Operational Research problems in chemical industries are recalled, as well as the conditions in which a dynamic program is illustrated by a sequential graph. A new algorithm for the determination of sub-optimal politics in a sequential graph is then developed. Finally, the applications of sub-optimality concept is shown when taking into account the indirect effects related to possible strategies, or in the case of stochastic choices and of problems of the siting of plants... application examples are given. (authors) [fr
Hsieh, Yeu-Shan; Chen, Shiu-Lien
The use of hunger strike as a tool to assert grievances has been around for ages and has occasionally happened in the world. Hunger strikers' motives may differ, but their tool is the same--the voluntary refusal of food. Fasting not only results in body weight loss, but also in physiological and neurological function changes, and, of course, it may even threaten life. The health care of hunger strikers is complex. It involves medical staff, medical ethics and guidance for the management of the hunger strikers. Improper medical management may not only undermine the hunger striker's dignity but also risk further damage to his or her health. By understanding hunger strikers' physiological changes and related ethical issues, therefore, we aim to identify appropriate forms of nursing care management and guidance for the care of hunger strikers.
Tan, Chong-Tin; Avanzini, Giuliano
There are three major issues of ethical concern related to epilepsy care in the developing world. First, is it ethical for a developing country to channel its limited resources from direct epilepsy care to research? The main considerations in addressing this question are the particular research questions to be addressed and whether such research will bring direct benefits to the local community. Second, in a country with limited resources, when does ignoring the high treatment gap become an ethical issue? This question is of particular concern when the community has enough resources to afford treatment for its poor, yet is not providing such care because of gross wastage and misallocation of the national resources. Third, do countries with plentiful resources have an ethical responsibility to help relieve the high epilepsy treatment gap of poor countries? Indeed, we believe that reasonable health care is a basic human right, and that human rights transcend national boundaries. Although health care is usually the responsibility of the nation-state, many modern states in the developing world are arbitrary creations of colonization. There is often a long process from the establishment of a political-legal state to a mature functional nation. During the long process of nation building, help from neighboring countries is often required.
Odell, Mandy; Gerber, Karin; Gager, Melanie
Patients can experience unexpected deterioration in their physiological condition that can lead to critical illness, cardiac arrest, admission to the intensive care unit and death. While ward staff can identify deterioration through monitoring physiological signs, these signs can be missed, interpreted incorrectly or mismanaged. Rapid response systems using early warning scores can fail if staff do not follow protocols or do not notice or manage deterioration adequately. Nurses often notice deterioration intuitively because of their knowledge of individual patients. Patients and their relatives have the greatest knowledge of patients, and can often pick up subtle signs physiological deterioration before this is identified by staff or monitoring systems. However, this ability has been largely overlooked. Call 4 Concern (C4C) is a scheme where patients and relatives can call critical care teams directly if they are concerned about a patient's condition- it is believed to be the first of its kind in the UK. A C4C feasibility project ran for six months, covering patients being transferred from the intensive care unit to general wards. C4C has the potential to prevent clinical deterioration and is valued by patients and relatives. Concerns of ward staff could be managed through project management. As it is relatively new, this field offers further opportunities for research.
Flávia Christiane de Azevedo Machado
Full Text Available The Specialized Dental Care Centers (SDCC have the mission to expand access to public medium complexity dental care and support the primary health care actions at this level of complexity. However, it is necessary to ensure the quality of services and to evaluate such services continuously to identify weaknesses and strengths that support the processes of leadership/management. Nevertheless, there is a dearth of studies on the assessment of oral health in specialized care that may indicate which factors should be investigated. Therefore, this integrated literature review sought to explore the plethora of publications on the evaluation of SDCC in the LILACS and MEDLINE data bases in October 2013 to identify factors possibly related to the performance of such health services. Thus, 13 references were included in this review pointing to forms of organization and management of work processes related to the creation of healthcare networks (operation of regulation centers and setting up of health consortiums. They include the contextual characteristics of the places where SDCCs are located (population size, Family Health Strategy coverage, Municipal Human Development Index, governance, governing capacity were factors that influenced the SDCCs performance.
Çelik, Sevim; Taşdemir, Nurten; Kurt, Aylin; İlgezdi, Ebru; Kubalas, Özge
Fatigue negatively affects the performance of intensive care nurses. Factors contributing to the fatigue experienced by nurses include lifestyle, psychological status, work organization and sleep problems. To determine the level of fatigue among nurses working in intensive care units and the related factors. This descriptive study was conducted with 102 nurses working in intensive care units in the West Black Sea Region of Turkey. Data were collected between February and May 2014 using a personal information form, the Visual Analogue Scale for Fatigue (VAS-F), the Hospital Anxiety and Depression Scale and the Pittsburg Sleep Quality Index. The intensive care nurses in the study were found to be experiencing fatigue. Significant correlations were observed between scores on the VAS-F Fatigue and anxiety (p=0.01), depression (p=0.002), and sleep quality (pnurses' levels of fatigue. These results can be of benefit in taking measures which may be used to reduce fatigue in nurses, especially the fatigue related to work organization and social life.
Full Text Available The South African prevention of mother to child transmission programme has made excellentprogress in reducing vertical HIV transmission, and paediatric antiretroviral therapyprogrammes have demonstrated good outcomes with increasing treatment initiation inyounger children and infants. However, both in South Africa and across sub-Saharan African,lack of boosted peri-partum prophylaxis for high-risk vertical transmission, loss to followup,and failure to initiate HIV-infected infants on antiretroviral therapy (ART before diseaseprogression are key remaining gaps in neonatal HIV-related care. In this issue of the Southern African Journal of HIV Medicine, experts provide valuable recommendations for addressingthese gaps. The present article highlights a number of areas where evidence is lacking toinform guidelines and programme development for optimal neonatal HIV-related care.
Full Text Available The present prospective study was carried out in the Paediatric Intensive Care Unit (PICU of a tertiary care teaching hospital in Mumbai. The objective was to determine the incidence, risk factors, mortality and organisms responsible for urinary catheter related infections (UCRI. Colonization and/or bacteriuria was labelled as urinary catheter related infection (UCRI. Forty-four patients with 51 urinary catheters were studied. Incidence of UCRI was 47.06%. Age, female sex and immunocompromised status did not increase the risk of UCRI. Duration of catheter in-situ and duration of stay in the PICU were associated with higher risk of UCRI. The mortality was not increased by UCRI. Commonest organism isolated in UCRI was E. coli, which had maximum susceptibility to nitrofurantoin and amikacin.
Roč. 5, č. 1 (2016), s. 171-182 ISSN 2226-5260 R&D Projects: GA ČR(CZ) GA16-23046S Institutional support: RVO:67985955 Keywords : phenomenology * care ethics * phenomenological ethics * enactivism * the lived body * intersubjectivity * relationality Subject RIV: AA - Philosophy ; Religion http://horizon.spb.ru/index.php?option=com_content&view=article&id=1038&lang=en
van Hout, Moniek S. E.; Schmand, Ben; Wekking, Ellie M.; Hageman, Gerard; Deelman, Betto G.
Suboptimal performance during neuropsychological testing can seriously complicate assessment in behavioral neurotoxicology. We present data on the prevalence of suboptimal performance in a group of Dutch patients with suspected chronic toxic encephalopathy (CTE) after long-term occupational exposure
van Hout, MSE; Schmand, B; Wekking, EM; Hageman, G; Deelman, BG
Suboptimal performance during neuropsychological testing can seriously complicate assessment in behavioral neurotoxicology. We present data on the prevalence of suboptimal performance in a group of Dutch patients with suspected chronic toxic encephalopathy (CTE) after long-term occupational exposure
McEwan, Kirsten; Gilbert, Paul; Duarte, Joana
Social mentality theory outlines how specialist systems have evolved to facilitate different types of social behaviour such as caring for offspring, forming alliances, and competing for resources. This research explored how different types of self-experience are linked to the different social mentalities of competitive social ranking (focusing on gaining and defending one's social position/status/rank) in contrast to caring (being helpful to others). Perceived low social rank (with feelings of being inferior and unfavourable social comparison, SC) has been linked to depression, but a caring sense of self has less so. We hypothesized therefore that depression, in both clinical and non-clinical populations, would be primarily linked to competitive and rank focused sense of self rather than a caring sense of self. Students (N = 312) and patients with depression (N = 48) completed self-report scales measuring: self-experience related to competitiveness and caring; social rank; social safeness; and depression, anxiety, and stress. The data suggest that in students, and particularly in patients, competitiveness (and feeling unsuccessful in competing for resources) is strongly associated with depression. Although caring shares a small correlation with depression in students, and with depression, anxiety, and stress in patients, when controlling for the rank variable of submissive behaviour this relationship ceases to be significant. Submissive behaviour was found to be a full mediator between caring and depression. We also found that how safe and comfortable one feels in one's social relationships (social safeness), was a full mediator between competitiveness and depression. So, it is the feeling of being unable to compete where one does not feel secure in one's social environment that is particularly linked to depression. The results of this study suggest that self-experience is complex and multifaceted and is linked to different social roles that are socially
Shor, M J; Miller, J C
Many opportunities exist today for orthopedic surgeons in the treatment and management of work-related injuries. Physicians wishing to enter or participate in this market must realize that the role of the physician in the treatment of the injured worker has expanded from one of being solely the care giver to being a patient manager, a problem solver, and a communicator. A number of years ago, many orthopedic surgeons missed out on managed care contracting for health maintenance organizations because they thought they could survive without it. They soon learned the challenges of sitting on the sidelines. Whether we like it or not, managed care for work-related injuries is here and its likelihood for going away is about zero. If your state has not yet adopted utilization management standards or managed care for workers' compensation-enabling legislation, when you wake up tomorrow they may have done so. Because of its relative embryonic development, there are exceptional opportunities for practitioners to take active roles in shaping the models that will serve employees and employers in the year 2000. Physicians who are interested in the treatment of injured workers have a unique opportunity right now to develop relationships in the managed workers' compensation arena. Payment and patient referrals for workers' compensation may turn out to be more attractive financially than many of the contracts currently in place with health maintenance organizations and other general health plans. Physicians willing to partner with employers and other players in the workers' compensation arena currently face some challenging, rewarding, and exciting opportunities. In the immortal words of Hippocrates, "Healing is a matter of time, but it is sometimes a matter of opportunity."3 It is unclear whether Hippocrates ever imagined our current level of science, practice, and organization, but it is clear the opportunities to be an active participant in the changes occurring in workers
Coast, Ernestina; Norris, Alison H; Moore, Ann M; Freeman, Emily
We present a new conceptual framework for studying trajectories to obtaining abortion-related care. It assembles for the first time all of the known factors influencing a trajectory and encourages readers to consider the ways these macro- and micro-level factors operate in multiple and sometimes conflicting ways. Based on presentation to and feedback from abortion experts (researchers, providers, funders, policymakers and advisors, advocates) (n = 325) between 03/06/2014 and 22/08/2015, and a systematic mapping of peer-reviewed literature (n = 424) published between 01/01/2011 and 30/10/2017, our framework synthesises the factors shaping abortion trajectories, grouped into three domains: abortion-specific experiences, individual contexts, and (inter)national and sub-national contexts. Our framework includes time-dependent processes involved in an individual trajectory, starting with timing of pregnancy awareness. This framework can be used to guide testable hypotheses about enabling and inhibiting influences on care-seeking behaviour and consideration about how abortion trajectories might be influenced by policy or practice. Research based on understanding of trajectories has the potential to improve women's experiences and outcomes of abortion-related care. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Community palliative care nurses in Perth have joined the throng of healthcare workers relying on personal digital assistants (PDAs) to store, access and send client information in 'real time'. This paper is guided by Heidegger's approach to technologies and Habermas' insights into the role of law in administering social welfare programs to reveal how new ethical and legal understandings regarding patient information add to nursing's professional responsibilities. This qualitative research interprets data from interviews with twenty community palliative care nurses about clients' legal rights to informational privacy and confidentiality. It explores nurses' views of their nursing responsibilities regarding clients' legal rights, liability issues, bureaucratic monitoring and enforcement procedures. It concludes that nurses and clients are construed as legal subjects entrenched in legal relations that have magnified since these nurses began using PDAs in 2005/2006. © 2011 Blackwell Publishing Ltd.
Rising, Russell; Scaglia, Julio F; Cole, Conrad; Tverskaya, Rozalia; Duro, Debora; Lifshitz, Fima
Abstract Background Energy and Zinc (Zn) deficiencies have been associated with nutritional related growth retardation as well as growth hormone (GH) resistance. In this study, the relationship between suboptimal energy and/or Zn intake and growth in rats and their response to immunoreactive exogenous recombinant human GH (GHi), was determined. Results Rats treated with GHi and fed ad-libitum energy and Zn (100/100) had increased IGFBP-3 (p < 0.05) as compared with NSS (215 ± 23 vs. 185 ± 17 ...
Gurtner, Caroline; Spirig, Rebecca; Staudacher, Diana; Huber, Evelyn
Patient-related complexity in nursing care - Collective case studies in the acute care hospital Abstract. Patient-related complexity of nursing is defined by the three characteristics "instability", "uncertainty", and "variability". Complexity increased in the past years, due to reduced hospital length of stay and a growing number of patients with chronic and multiple diseases. We investigated the phenomenon of patient-related complexity from the point of view of nurses and clinical nurse specialists in an acute care hospital. In the context of a collective case study design, nurses and clinical nurse specialists assessed the complexity of nursing situations with a questionnaire. Subsequently, we interviewed nurses and clinical nurse specialists about their evaluation of patient-related complexity. In a within-case-analysis we summarized data inductively to create case narratives. By means of a cross-case-analysis we compared the cases with regard to deductively derived characteristics. The four cases exemplarily showed that the degree of complexity depends on the controllability and predictability of clinical problems. Additionally, complexity increases or decreases, according to patients' individual resources. Complex patient situations demand professional expertise, experience, communicative competencies and the ability for reflection. Beginner nurses would benefit from support and advice by experienced nurses to develop these skills.
Brantsæter, Anne Lise; Abel, Marianne Hope; Haugen, Margaretha; Meltzer, Helle Margrete
Pregnant women and infants are exceptionally vulnerable to iodine deficiency. The aims of the present study were to estimate iodine intake, to investigate sources of iodine, to identify predictors of low or suboptimal iodine intake (defined as intakes below 100 μg/day and 150 μg/day) in a large population of pregnant Norwegian women and to evaluate iodine status in a sub-population. Iodine intake was calculated based on a validated Food Frequency Questionnaire in the Norwegian Mother and Child Cohort. The median iodine intake was 141 μg/day from food and 166 μg/day from food and supplements. Use of iodine-containing supplements was reported by 31.6%. The main source of iodine from food was dairy products, contributing 67% and 43% in non-supplement and iodine-supplement users, respectively. Of 61,904 women, 16.1% had iodine intake below 100 μg/day, 42.0% had iodine intake below 150 μg/day and only 21.7% reached the WHO/UNICEF/ICCIDD recommendation of 250 μg/day. Dietary behaviors associated with increased risk of low and suboptimal iodine intake were: no use of iodine-containing supplements and low intake of milk/yogurt, seafood and eggs. The median urinary iodine concentration measured in 119 participants (69 μg/L) confirmed insufficient iodine intake. Public health strategies are needed to improve and secure the iodine status of pregnant women in Norway.
Nguyen, J; Muniraman, H; Cascione, M; Ramanathan, R
Maternal-fetal medicine physicians (MFMp) and neonatal-perinatal medicine physicians (NPMp) caring for premature infants and their families are exposed to significant risk for malpractice actions. Effective communication practices have been implicated to decrease litigious intentions but the extent of miscommunication as a cause of legal action is essentially unknown in this population. Analysis of communication-related allegations (CRAs) may help toward improving patient care and physician-patient relationships as well as decrease litigation risks. We retrospectively reviewed the Westlaw database, a primary online legal research resource used by United States lawyers and legal professionals, for malpractice cases against physicians involving premature infants. Inclusion criteria were: 22 to 36 weeks gestational age, cases related to peripartum events through infant discharge and follow-up, and legal records with detailed factual narratives. The search yielded 736 legal records, of which 167 met full inclusion criteria. A CRA was identified in 29% (49/167) of included cases. MFMp and/or NPMp were named in 104 and 54 cases, respectively. CRAs were identified in 26% (27/104) and 35% (19/54) of MFMp- and NPMp-named cases, respectively, with a majority involving physician-family for both specialties (81% and 74%, respectively). Physician-family CRAs for MFMp and NPMp most often regarded lack of informed consent (50% and 57%, respectively), lack of full disclosure (41% and 29%, respectively) and lack of anticipatory guidance (36% and 21%, respectively). This study of a major legal database identifies CRAs as significant causes of legal action against MFMp and NPMp involved in the care of high-risk women and infants delivered preterm. Physicians should be especially vigilant with obtaining genuine informed consent and maintaining open communication with families.
Full Text Available Faridah Md Yusof Aryani,1 Shaun Wen Huey Lee,2 Siew Siang Chua,3 Li Ching Kok,4 Benny Efendie,2 Thomas Paraidathathu5 1Pharmaceutical Services Division, Ministry of Health Malaysia, Petaling Jaya, 2School of Pharmacy, Monash University Malaysia, Bandar Sunway, 3Department of Pharmacy, Faculty of Medicine, University of Malaya, 4Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, 5School of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia Purpose: Chronic diseases such as hypertension, diabetes mellitus, and hyperlipidemia are public health concerns. However, little is known about how these affect patient-level health measures. The aim of the study was to examine the impact of a chronic care model (CCM on the participant’s health-related quality of life (QoL. Patients and methods: Participants received either usual care or CCM by a team of health care professionals including pharmacists, nurses, dietitians, and general practitioners. The participants in the intervention group received medication counseling, adherence, and dietary advice from the health care team. The QoL was measured using the EQ-5D (EuroQoL-five dimension, health-related quality of life questionnaire and comparison was made between usual care and intervention groups at the beginning and end of the study at 6 months. Results: Mean (standard deviation EQ-5D index scores improved significantly in the intervention group (0.92±0.10 vs 0.95±0.08; P≤0.01, but not in the usual care group (0.94±0.09 vs 0.95±0.09; P=0.084. Similarly, more participants in the intervention group reported improvements in their QoL compared with the usual care group, especially in the pain/discomfort and anxiety/depression dimensions. Conclusion: The implementation of the CCM resulted in significant improvement in QoL. An interdisciplinary team CCM approach should be encouraged, to ultimately result in behavior changes and improve the QoL of the patients. Keywords: diabetes
Julie L.V. Shaw
Full Text Available Point of care testing (POCT refers to laboratory testing that occurs near to the patient, often at the patient bedside. POCT can be advantageous in situations requiring rapid turnaround time of test results for clinical decision making. There are many challenges associated with POCT, mainly related to quality assurance. POCT is performed by clinical staff rather than laboratory trained individuals which can lead to errors resulting from a lack of understanding of the importance of quality control and quality assurance practices. POCT is usually more expensive than testing performed in the central laboratory and requires a significant amount of support from the laboratory to ensure the quality testing and meet accreditation requirements.Here, specific challenges related to POCT compliance with accreditation standards are discussed along with strategies that can be used to overcome these challenges. These areas include: documentation of POCT orders, charting of POCT results as well as training and certification of individuals performing POCT. Factors to consider when implementing connectivity between POCT instruments and the electronic medical record are also discussed in detail and include: uni-directional versus bidirectional communication, linking patient demographic information with POCT software, the importance of positive patient identification and considering where to chart POCT results in the electronic medical record. Keywords: Point of care Testing, Laboratory accreditation, Medical directive, Results documentation, Electronic Medical Record, Transcription error, Connectivity, Positive patient identification
Lindhardt, Tove; Nyberg, Per; Hallberg, Ingalill Rahm
in care. A new role for relatives as partners in decision-making rather than passive recipients of information is indicated for the benefit of care quality. Further, increased collaboration between relatives and nurses, assigning relatives' influence, may reduce their powerlessness and guilt and thereby......BACKGROUND: Relatives are often involved in the care of frail elderly patients prior to admission and are thus important collaborative partners for nurses. They hold valuable knowledge, which may improve care planning for the benefit of the patient and the hospital care trajectory. Satisfaction...... among relatives may be an indicator of this. Aim: To investigate collaboration between relatives and nurses among those relatives reporting high versus low satisfaction with the hospital care trajectory. Further, the aim was to investigate the relationship between satisfaction with the hospital care...
Elyse H Norton
Full Text Available Humans often make decisions based on uncertain sensory information. Signal detection theory (SDT describes detection and discrimination decisions as a comparison of stimulus "strength" to a fixed decision criterion. However, recent research suggests that current responses depend on the recent history of stimuli and previous responses, suggesting that the decision criterion is updated trial-by-trial. The mechanisms underpinning criterion setting remain unknown. Here, we examine how observers learn to set a decision criterion in an orientation-discrimination task under both static and dynamic conditions. To investigate mechanisms underlying trial-by-trial criterion placement, we introduce a novel task in which participants explicitly set the criterion, and compare it to a more traditional discrimination task, allowing us to model this explicit indication of criterion dynamics. In each task, stimuli were ellipses with principal orientations drawn from two categories: Gaussian distributions with different means and equal variance. In the covert-criterion task, observers categorized a displayed ellipse. In the overt-criterion task, observers adjusted the orientation of a line that served as the discrimination criterion for a subsequently presented ellipse. We compared performance to the ideal Bayesian learner and several suboptimal models that varied in both computational and memory demands. Under static and dynamic conditions, we found that, in both tasks, observers used suboptimal learning rules. In most conditions, a model in which the recent history of past samples determines a belief about category means fit the data best for most observers and on average. Our results reveal dynamic adjustment of discrimination criterion, even after prolonged training, and indicate how decision criteria are updated over time.
Turner, Richard M; Yin, Peng; Hanson, Anita; FitzGerald, Richard; Morris, Andrew P; Stables, Rod H; Jorgensen, Andrea L; Pirmohamed, Munir
High-potency statin therapy is recommended in the secondary prevention of cardiovascular disease but discontinuation, dose reduction, statin switching, and/or nonadherence occur in practice. To determine the prevalence and predictors of deviation from high-potency statin use early after a non-ST elevation acute coronary syndrome (NSTE-ACS) and its association with subsequent major adverse cardiovascular events (MACE) and all-cause mortality (ACM). A total of 1005 patients from a UK-based prospective NSTE-ACS cohort study discharged on high-potency statin therapy (atorvastatin 80 mg, rosuvastatin 20 mg, or 40 mg daily) were included. At 1 month, patients were divided into constant high-potency statin users, and suboptimal users incorporating statin discontinuation, dose reduction, switching statin to a lower equivalent potency, and/or statin nonadherence. Follow-up was a median of 16 months. There were 156 suboptimal (∼15.5%) and 849 constant statin users. Factors associated in multivariable analysis with suboptimal statin occurrence included female sex (odds ratio 1.75, 95% confidence interval [CI] 1.14-2.68) and muscular symptoms (odds ratio 4.28, 95% CI 1.30-14.08). Suboptimal statin use was associated with increased adjusted risks of time to MACE (hazard ratio 2.10, 95% CI 1.25-3.53, P = .005) and ACM (hazard ratio 2.46, 95% CI 1.38-4.39, P = .003). Subgroup analysis confirmed that the increased MACE/ACM risks were principally attributable to statin discontinuation or nonadherence. Conversion to suboptimal statin use is common early after NSTE-ACS and is partly related to muscular symptoms. Statin discontinuation or non-adherence carries an adverse prognosis. Interventions that preserve and enhance statin utilization could improve post NSTE-ACS outcomes. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.
Ellis, Tina-Marie; Foote, Kelly D; Fernandez, Hubert H; Sudhyadhom, Atchar; Rodriguez, Ramon L; Zeilman, Pamela; Jacobson, Charles E; Okun, Michael S
To examine a case series of reoperations for deep brain stimulation (DBS) leads in which clinical scenarios revealed suboptimal outcome from a previous operation. Suboptimally placed DBS leads are one potential reason for unsatisfactory results after surgery for Parkinson's disease (PD), essential tremor (ET), or dystonia. In a previous study of patients who experienced suboptimal results, 19 of 41 patients had misplaced leads. Similarly, another report commented that lead placement beyond a 2- to 3-mm window resulted in inadequate clinical benefit, and, in 1 patient, revision improved outcome. The goal of the current study was to perform an unblinded retrospective chart review of DBS patients with unsatisfactory outcomes who presented for reoperation. Patients who had DBS lead replacements after reoperation were assessed with the use of a retrospective review of an institutional review board-approved movement disorders database. Cases of reoperation for suboptimal clinical benefit were included, and cases of replacement of DBS leads caused by infection or hardware malfunction were excluded. Data points studied included age, disease duration, diagnosis, motor outcomes (the Unified Parkinson Disease Rating Scale III in PD, the Tremor Rating Scale in ET, and the Unified Dystonia Rating Scale in dystonia), quality of life (Parkinson's Disease Questionnaire-39 in PD), and the Clinician Global Impression scale. The data from before and after reoperation were examined to determine the estimated impact of repeat surgery. There were 11 patients with PD, 7 with ET, and 4 with dystonia. The average age of the PD group was 52 years, the disease duration was 10 years, and the average vector distance of the location of the active DBS contact was adjusted 5.5 mm. Six patients (54%) with PD had preoperative off medication on DBS Unified Parkinson Disease Rating Scale scores that could be compared with postoperative off medication on DBS scores. The average improvement across this
Dhar, V Erica
This article concerns how globalization and the aging of the world's population are affecting the already complex issue of intergenerational transnational caregiving. Globalization has caused an increase in workforce mobility with large numbers of individuals seeking employment overseas. This, coupled with increased longevity globally, has resulted in many workers leaving their elderly parents in need of care in their home countries. This has spawned caregiving across national borders, or caring for family relations across nations. Currently in the United States, not enough emphasis is given to family caregiving. Data compiled by AARP and the National Alliance for Caregiving estimate the economic value for this group of family caregivers in 2007 to be $375 billion, accounting for 34-52 million family caregivers per given year. This does not include those families who are transnational caregivers. The seminal work in this emerging field has been done by social anthropologists Loretta Baldassar, Cora Velekoop Baldock, and Raelene Wilding, who have defined the components of transnational caregiving based on an ethnographic study using qualitative data to study nine immigrant communities in Western Australia. Although their research focused on caregiving from a distance, additional work has been added to the discussion by introducing the element of "care drain" and further cultural perspectives. Therefore, this research is an exploratory study on intergenerational transnational caregiving within the context of the changing world and its demographics. Within the context of globalization and global aging, the following questions are addressed: What is the significance of family caregiving? What is a transnational? How has technology changed "transnationalism" today? What are the elements that comprise transnational caregiving? How does culture play a role in transnational caregiving? What are some of the national initiatives undertaken by governments to aid in workforce
Elstad, Jon Ivar
This study examines income inequalities in foregone dental care in 23 European countries during the years with global economic crisis. Associations between dental care coverage from public health budgets or social insurance, and income-related inequalities in perceived access to dental care, are analysed. Survey data 2008-2013 from 23 countries were combined with country data on macro-economic conditions and coverage for dental care. Foregone dental care was defined as self-reported abstentions from needed dental care because of costs or other crisis-related reasons. Age-standardized percentages reporting foregone dental care were estimated for respondents, age 20-74, in the lowest and highest income quartile. Associations between dental care coverage and income inequalities in foregone dental care, adjusted for macro-economic indicators, were examined by country-level regression models. In all 23 countries, respondents in the lowest income quartile reported significantly higher levels of foregone dental care than respondents in the highest quartile. During 2008-2013, income inequalities in foregone dental care widened significantly in 13 of 23 countries, but decreased in only three countries. Adjusted for countries' macro-economic situation and severity of the economic crisis, higher dental care coverage was significantly associated with smaller income inequalities in foregone dental care and less widening of these inequalities. Income-related inequalities in dental care have widened in Europe during the years with global economic crisis. Higher dental care coverage corresponded to less income-related inequalities in foregone dental care and less widening of these inequalities. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Joshi, Beena; Chauhan, Sanjay; Pasi, Achhelal; Kulkarni, Ragini; Sunil, Nithya; Bachani, Damodar; Mankeshwar, Ranjit
National Anti-retroviral treatment (ART) programme in India was launched in 2004. Since then, there has been no published country representative estimate of suboptimal adherence among people living with HIV (PLHIV) on first line ART in public settings. Hence a multicentric study was undertaken in 15 States of India to assess the level of suboptimal adherence and its determinants among PLHIV. Using a prospective observational study design, 3285 PLHIV were enrolled and followed up to six months across 30 ART centres in India. Adherence was assessed using pill count and self-reported recall method and determinants of suboptimal adherence were explored based on the responses to various issues as perceived by them. Suboptimal adherence was found in 24.5 per cent PLHIV. Determinants of suboptimal adherence were illiteracy (OR--1.341, CI--1.080-1.665), on ART for less than 6 months (OR--1.540, CI--1.280-1.853), male gender (OR for females--0.807, CI--0.662-0.982), tribals (OR--2.246, CI--1.134-4.447), on efavirenz (EFA) regimen (OR--1.479, CI--1.190-1.837), presence of anxiety (OR--1.375, CI--1.117-1.692), non-disclosure of HIV status to family (OR--1.549, CI--1.176-2.039), not motivated for treatment (OR--1.389, CI--1.093-1.756), neglect from friends (OR--1.368, CI--1.069-1.751), frequent change of residence (OR--3.373, CI--2.659-4.278), travel expenses (OR--1.364, CI--1.138-1.649), not meeting the PLHIV volunteer/community care coordinator at the ART center (OR--1.639, CI--1.330-2.019). To enhance identification of PLHIV vulnerable to suboptimal adherence, the existing checklist to identify the barriers to adherence in the National ART Guidelines needs to be updated based on the study findings. Quality of comprehensive adherence support services needs to be improved coupled with vigilant monitoring of adherence measurement.
Full Text Available Background & objectives: National Anti-retroviral treatment (ART programme in India was launched in 2004. Since then, there has been no published country representative estimate of suboptimal adherence among people living with HIV (PLHIV on first line ART in public settings. Hence a multicentric study was undertaken in 15 States of India to assess the level of suboptimal adherence and its determinants among PLHIV. Methods: Using a prospective observational study design, 3285 PLHIV were enrolled and followed up to six months across 30 ART centres in India. Adherence was assessed using pill count and self-reported recall method and determinants of suboptimal adherence were explored based on the responses to various issues as perceived by them. Results: Suboptimal adherence was found in 24.5 per cent PLHIV. Determinants of suboptimal adherence were illiteracy (OR-1.341, CI-1.080-1.665 , on ART for less than 6 months (OR-1.540, CI- 1.280-1.853, male gender (OR for females -0.807, CI- 0.662-0.982, tribals (OR-2.246, CI-1.134-4.447, on efavirenz (EFA regimen (OR- 1.479, CI - 1.190 - 1.837, presence of anxiety (OR- 1.375, CI - 1.117 - 1.692, non-disclosure of HIV status to family (OR- 1.549, CI - 1.176 - 2.039, not motivated for treatment (OR- 1.389, CI - 1.093 - 1.756, neglect from friends (OR-1.368, CI-1.069-1.751, frequent change of residence (OR- 3.373, CI - 2.659 - 4.278, travel expenses (OR- 1.364, CI - 1.138-1.649, not meeting the PLHIV volunteer/community care coordinator at the ART center (OR-1.639, CI-1.330-2.019. Interpretation & conclusions: To enhance identification of PLHIV vulnerable to suboptimal adherence, the existing checklist to identify the barriers to adherence in the National ART Guidelines needs to be updated based on the study findings. Quality of comprehensive adherence support services needs to be improved coupled with vigilant monitoring of adherence measurement.
Ramamoorthy, Padmapriya; Sinnott, Loraine T; Nichols, Jason J
To examine the effect of general contact lens and material characteristics, care solutions, treatment, and patient-related factors on contact lens-related dry eye. The data were derived from the Contact Lens and Dry Eye Study, designed as a cross-sectional and nested case-control study including 360 subjects. In separate statistical models, logistic regression was used to examine general contact lens characteristics, specific hydrogel lens materials, care solutions, and patient-related factors associated with dry eye status (controlled for age, gender, and current treatments). Several factors were significantly associated with dry eye, including treatment factors such as a recent contact lens refitting (odds ratios [OR] = 5.75, 95% confidence intervals [CI] = 2.14 to 15.46) and use of artificial tears/rewetting drops (OR = 1.09, 95% CI = 1.02 to 1.16), in addition, currently worn materials including Food and Drug Administration (FDA) group II (OR = 2.98, 95% CI = 1.14 to 6.19) and IV (OR = 1.87, 95% CI = 1.08 to 3.24). Significant patient-related factors included decreased overall satisfaction (OR = 3.57, 95% CI = 2.08 to 5.88,), dry eye in the absence of contact lens wear (OR = 6.54, 95% CI = 2.57 to 16.62), reduced daily lens wear duration (OR = 1.16, 95% CI = 1.06 to 1.26), and reduced ability to wear lenses as long as desired (OR = 2.44, 95% CI = 1.30 to 4.54). Care solutions were not associated with contact lens-related dry eye. The strong association of common treatment factors with dry eye status in contact lens wearers suggests that these treatments are not entirely effective. The use of high water content materials was strongly related to dry eye in lens wearers, whereas care solutions were not. Contact lens-related dry eye was also associated with several patient-related factors such as greater ocular discomfort (without lenses), dissatisfaction, and inability to wear lenses for desired durations.
Shaw, Julie L V
Point of care testing (POCT) refers to laboratory testing that occurs near to the patient, often at the patient bedside. POCT can be advantageous in situations requiring rapid turnaround time of test results for clinical decision making. There are many challenges associated with POCT, mainly related to quality assurance. POCT is performed by clinical staff rather than laboratory trained individuals which can lead to errors resulting from a lack of understanding of the importance of quality control and quality assurance practices. POCT is usually more expensive than testing performed in the central laboratory and requires a significant amount of support from the laboratory to ensure the quality testing and meet accreditation requirements. Here, specific challenges related to POCT compliance with accreditation standards are discussed along with strategies that can be used to overcome these challenges. These areas include: documentation of POCT orders, charting of POCT results as well as training and certification of individuals performing POCT. Factors to consider when implementing connectivity between POCT instruments and the electronic medical record are also discussed in detail and include: uni-directional versus bidirectional communication, linking patient demographic information with POCT software, the importance of positive patient identification and considering where to chart POCT results in the electronic medical record.
Rising, Russell; Lifshitz, Fima
Sub-optimally nourished rats show reduced growth, biochemical and physiological changes. However, no one has assessed metabolic rate adaptations in rats subjected to chronic suboptimal nutrition (CSN). In this study energy expenditure (EE; kcal/100 g body weight) and physical activity (PA; oscillations in weight/min/kg body weight) were assessed in rats subjected to three levels of CSN. Body weight gain was diminished (76.7 +/- 12.0 and 61.6 +/- 11.0 g) in rats fed 70 and 60% of the ad-libitum fed controls which gained more weight (148.5 +/- 32.3 g). The rats fed 80% gained weight similarly to controls (136.3 +/- 10.5 g). Percent Fat-free body mass was reduced (143.8 +/- 8.7 and 142.0 +/- 7.6 g) in rats fed 70 and 60% of ad-libitum, but not in those fed 80% (200.8 +/- 17.5 g) as compared with controls (201.6 +/- 33.4 g). Body fat (g) decreased in rats fed 80% (19.7 +/- 5.3), 70% (15.3 +/- 3.5) and 60% (9.6 +/- 2.7) of ad-libitum in comparison to controls (26.0 +/- 6.7). EE and PA were also altered by CSN. The control rats increased their EE and PA during the dark periods by 1.4 +/- 0.8 and 1.7 +/- 1.1 respectively, as compared with light the period; whereas CSN rats fed 80 and 70% of ad-libitum energy intake had reduced EE and PA during the dark periods as compared with the light period EE(7.5 +/- 1.4 and 7.8 +/- 0.6 vs. 9.0 +/- 1.2 and 9.7 +/- 0.8; p vs. 4.1 +/- 0.9 and 2.4 +/- 0.4; p vs. 0.95 +/- 0.03 and 0.91 +/- 0.05 p light (7.1 +/- 1.4) and dark period (6.2 +/- 1.0) EE and PA (3.4 +/- 0.9 and 2.5 +/- 0.5 respectively) were reduced in rats fed 60% of ad-libitum energy intake. CSN rats adapt to mild energy restriction by reducing body fat, EE and PA mainly during the dark period while growth proceeds and lean body mass is preserved. At higher levels of energy restrictions there is decreased growth, body fat and lean mass. Moreover EE and PA are also reduced during both light and dark periods.
Full Text Available Abstract Background Sub-optimally nourished rats show reduced growth, biochemical and physiological changes. However, no one has assessed metabolic rate adaptations in rats subjected to chronic suboptimal nutrition (CSN. In this study energy expenditure (EE; kcal/100 g body weight and physical activity (PA; oscillations in weight/min/kg body weight were assessed in rats subjected to three levels of CSN. Results Body weight gain was diminished (76.7 ± 12.0 and 61.6 ± 11.0 g in rats fed 70 and 60% of the ad-libitum fed controls which gained more weight (148.5 ± 32.3 g. The rats fed 80% gained weight similarly to controls (136.3 ± 10.5 g. Percent Fat-free body mass was reduced (143.8 ± 8.7 and 142.0 ± 7.6 g in rats fed 70 and 60% of ad-libitum, but not in those fed 80% (200.8 ± 17.5 g as compared with controls (201.6 ± 33.4 g. Body fat (g decreased in rats fed 80% (19.7 ± 5.3, 70% (15.3 ± 3.5 and 60% (9.6 ± 2.7 of ad-libitum in comparison to controls (26.0 ± 6.7. EE and PA were also altered by CSN. The control rats increased their EE and PA during the dark periods by 1.4 ± 0.8 and 1.7 ± 1.1 respectively, as compared with light the period; whereas CSN rats fed 80 and 70% of ad-libitum energy intake had reduced EE and PA during the dark periods as compared with the light period EE(7.5 ± 1.4 and 7.8 ± 0.6 vs. 9.0 ± 1.2 and 9.7 ± 0.8; p Conclusion CSN rats adapt to mild energy restriction by reducing body fat, EE and PA mainly during the dark period while growth proceeds and lean body mass is preserved. At higher levels of energy restrictions there is decreased growth, body fat and lean mass. Moreover EE and PA are also reduced during both light and dark periods.
Wu, Shengwei; Xuan, Zhengzheng; Li, Fei; Xiao, Wei; Fu, Xiuqiong; Jiang, Pingping; Chen, Jieyu; Xiang, Lei; Liu, Yanyan; Nie, Xiaoli; Luo, Ren; Sun, Xiaomin; Kwan, Hiuyee; Zhao, Xiaoshan
Suboptimal health status (SHS)—an intermediate state between health and illness—refers to functional somatic symptoms that are medically undiagnosed. Although SHS has become a great challenge for global public health, very little about its etiology and mechanisms are known. Work-recreation balance is a part of work−life balance, and is related to stress which greatly influences health status. We therefore carried out a cross-sectional investigation between 2012 and 2013 within a clustered sam...
Incremona, Gian Paolo; Cucuzzella, Michele; Ferrara, Antonella
This paper deals with the design of adaptive suboptimal second-order sliding mode (ASSOSM) control laws for grid-connected microgrids. Due to the presence of the inverter, of unpredicted load changes, of switching among different renewable energy sources, and of electrical parameters variations, the microgrid model is usually affected by uncertain terms which are bounded, but with unknown upper bounds. To theoretically frame the control problem, the class of second-order systems in Brunovsky canonical form, characterised by the presence of matched uncertain terms with unknown bounds, is first considered. Four adaptive strategies are designed, analysed and compared to select the most effective ones to be applied to the microgrid case study. In the first two strategies, the control amplitude is continuously adjusted, so as to arrive at dominating the effect of the uncertainty on the controlled system. When a suitable control amplitude is attained, the origin of the state space of the auxiliary system becomes attractive. In the other two strategies, a suitable blend between two components, one mainly working during the reaching phase, the other being the predominant one in a vicinity of the sliding manifold, is generated, so as to reduce the control amplitude in steady state. The microgrid system in a grid-connected operation mode, controlled via the selected ASSOSM control strategies, exhibits appreciable stability properties, as proved theoretically and shown in simulation.
Full Text Available The main drawback of closed-form solution of linearly constrained minimum variance (CF-LCMV beamformer is the dilemma of acquiring long observation time for stable covariance matrix estimates and short observation time to track dynamic behavior of targets, leading to poor performance including low signal-noise-ratio (SNR, low jammer-to-noise ratios (JNRs and small number of snapshots. Additionally, CF-LCMV suffers from heavy computational burden which mainly comes from two matrix inverse operations for computing the optimal weight vector. In this paper, we derive a low-complexity Robust Adaptive LCMV beamformer based on an Iterative Suboptimal solution (RAIS-LCMV using conjugate gradient (CG optimization method. The merit of our proposed method is threefold. Firstly, RAIS-LCMV beamformer can reduce the complexity of CF-LCMV remarkably. Secondly, RAIS-LCMV beamformer can adjust output adaptively based on measurement and its convergence speed is comparable. Finally, RAIS-LCMV algorithm has robust performance against low SNR, JNRs, and small number of snapshots. Simulation results demonstrate the superiority of our proposed algorithms.
Bell, Sue Anne; Seng, Julia
Objective To test the hypothesis that childhood maltreatment history would be associated with inadequate prenatal care utilization. Design A post-hoc analysis of a prospective cohort study of the effects of post traumatic stress disorder (PTSD) on pregnancy outcomes. Setting Recruitment took place via prenatal clinics from three academic health systems in southeast Michigan. Participants This analysis included 467 diverse, nulliparous, English-speaking adult women expecting their first infants. Methods Data were gathered from structured telephone interviews at two time points in pregnancy and from prenatal medical records. Results Contrary to our hypothesis, history of childhood maltreatment was associated with better likelihood of using adequate prenatal care. Risk for inadequate prenatal care occurred in association with the posttraumatic stress and interpersonal sensitivity that can result from maltreatment, with low alliance with the maternity care provider, and with public insurance coverage. Prior mental health treatment was associated with using adequate prenatal care. Conclusion When childhood maltreatment survivors were resilient or have used mental health treatment, they were more likely to utilize adequate prenatal care. The maternity care relationship or service delivery model (e.g., no continuity of care) as well as structural factors may adversely affect utilization among PTSD-affected survivors. Since inadequate care was associated with adverse outcomes, further studies of these modifiable factors are warranted. PMID:23772546
Hildingsson, Ingegerd; Cederlöf, Linnea; Widén, Sara
The aim was to identify the proportion of fathers having a positive experience of a normal birth and to explore factors related to midwifery care that were associated with a positive experience. Research has mainly focused on the father's supportive role during childbirth rather than his personal experiences of birth. 595 new fathers living in a northern part of Sweden, whose partner had a normal birth, were included in the study. Data was collected by questionnaires. Odds Ratios with 95% confidence interval and logistic regression analysis were used. The majority of fathers (82%) reported a positive birth experience. The strongest factors associated with a positive birth experience were midwife support (OR 4.0; 95 CI 2.0-8.1), the midwife's ongoing presence in the delivery room (OR 2.0; 1.1-3.9), and information about the progress of labour (OR 3.1; 1.6-5.8). Most fathers had a positive birth experience. Midwifery support, the midwife's presence and sufficient information about the progress of labour are important aspects in a father's positive birth experience. The role of the midwife during birth is important to the father, and his individual needs should be considered in order to enhance a positive birth experience. Copyright © 2010 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
, it is unclear which contextual, individual, and product-related factors impact consumer likelihood of choice and thus acceptance of the practice in the long run. The study aimed at exploring the effect of communicating different motives for purchase, the product being organic, familiarity with the practice...... and the interaction with gender is observed for milk in particular. Overall, perceived quality and estimated likelihood of consumption at home majorly determine likelihood of choice. Consumer acceptance of expiration date based pricing of suboptimal food can be increased through furthering consumer familiarity......Consumers have been found to majorly prefer ‘optimal’ food over ‘suboptimal’ when purchasing food. To provide an incentive for consumers to select suboptimal food and thus decrease food waste in the supply chain, expiration date based pricing is suggested and increasingly applied. However...
Tilley, Lorna; Cameron, Tony
The Index of Care is a web-based application designed to support the recently proposed four-stage 'bioarchaeology of care' methodology for identifying and interpreting health-related care provision in prehistory. The Index offers a framework for guiding researchers in 'thinking through' the steps of a bioarchaeology of care analysis; it continuously prompts consideration of biological and archaeological evidence relevant to care provision; it operationalises key concepts such as 'disability' and 'care'; and it encourages transparency in the reasoning underlying conclusions, facilitating review. This paper describes the aims, structure and content of the Index, and provides an example of its use. The Index of Care is freely available on-line; it is currently in active development, and feedback is sought to improve its utility and usability. This is the first time in bioarchaeology that an instrument for examining behaviour as complex as caregiving has been proposed. Copyright © 2014 Elsevier Inc. All rights reserved.
Cappellini, Elena; Bambi, Stefano; Lucchini, Alberto; Milanesio, Erika
The aims of this study were to describe the current status of intensive care unit (ICU) visiting hours policies internationally and to explore the influence of ICUs' open visiting policies on patients', visitors', and staff perceptions, as well as on patients' outcomes. A review of the literature was done through MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. The following keywords were searched: "visiting," "hours," "ICU," "policy," and "intensive care unit." Inclusion criteria for the review were original research paper, adult ICU, articles published in the last 10 years, English or Italian language, and available abstract. Twenty-nine original articles, mainly descriptive studies, were selected and retrieved. In international literature, there is a wide variability about open visiting policies in ICUs. The highest percentage of open ICUs is reported in Sweden (70%), whereas in Italy there is the lowest rate (1%). Visiting hours policies and number of allowed relatives are variable, from limits of short precise segments to 24 hours and usually 2 visitors. Open ICUs policy/guidelines acknowledge concerns with visitor hand washing to prevent the risk of infection transmission to patients. Patients, visitors, and staff seem to be inclined to support open ICU programs, although physicians are more inclined to the enhancement of visiting hours than nurses. The percentages of open ICUs are very different among countries. It can be due to local factors, cultural differences, and lack of legislation or hospital policy. There is a need for more studies about the impact of open ICUs programs on patients' mortality, length of stay, infections' risk, and the mental health of patients and their relatives.
Kirk Stodola; Eric Linder; David A. Buehler; Kathlee Franzreb; Daniel Kim; Robert Cooper
Biparental care is common in birds with the allocation of effort being highly variable between the sexes. In most songbird species, the female typically provides the most care in the breeding cycle with both parents providing care when provisioning young. Food provisioning should be directly related to offspring quality; however, the relative influence each parent has...
Zúñiga, Franziska; Ausserhofer, Dietmar; Hamers, Jan P H; Engberg, Sandra; Simon, Michael; Schwendimann, René
To describe care worker-reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care. Cross-sectional study. National, randomly selected sample of Swiss nursing homes, stratified according to language region and size. A total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013. Care worker-reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale-Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care. Overall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36-8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08-4.15); less stress due to workload (OR 0.71, 95% CI 0.55-0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24-0.49); and less rationing of social care (OR 0.80, 95% CI 0.69-0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care. Work environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
Chung, Yao-Liang; Tsai, Zsehong
Power consumption due to transmissions in base stations (BSs) has been a major contributor to communication-related CO2 emissions. A power optimization model is developed in this study with respect to radio resource allocation and activation in a multiple Component Carrier (CC) environment. We formulate and solve the power-minimization problem of the BS transceivers for multiple-CC networks with carrier aggregation, while maintaining the overall system and respective users' utilities above minimum levels. The optimized power consumption based on this model can be viewed as a lower bound of that of other algorithms employed in practice. A suboptimal scheme with low computation complexity is proposed. Numerical results show that the power consumption of our scheme is much better than that of the conventional one in which all CCs are always active, if both schemes maintain the same required utilities.
M. de la Sen
Full Text Available This paper focuses on the suboptimization of a class of multivariable discrete-time bilinear systems consisting of interconnected bilinear subsystems with respect to a linear quadratic optimal regulation criterion which involves the use of state weighting terms only. Conditions which ensure the controllability of the overall system are given as a previous requirement for optimization. Three transformations of variables are made on the system equations in order to implement the scheme on an equivalent linear system. This leads to an equivalent representation of the used quadratic performance index that involves the appearance of quadratic weighting terms related to both transformed input and state variables. In this way, a Riccati-matrix sequence, allowing the synthesis of a standard feedback control law, is obtained. Finally, the proposed control scheme is tested on realistic examples.
Fortes, Inês; Pinto, Carlos; Machado, Armando; Vasconcelos, Marco
When offered a choice between 2 alternatives, animals sometimes prefer the option yielding less food. For instance, pigeons and starlings prefer an option that on 20% of the trials presents a stimulus always followed by food, and on the remaining 80% of the trials presents a stimulus never followed by food (the Informative Option), over an option that provides food on 50% of the trials regardless of the stimulus presented (the Noninformative Option). To explain this suboptimal behavior, it has been hypothesized that animals ignore (or do not engage with) the stimulus that is never followed by food in the Informative Option. To assess when pigeons attend to the stimulus usually not followed by food, we increased the probability of reinforcement, p, in the presence of that stimulus. Across 2 experiments, we found that the value of the Informative Option decreased with p. To account for the results, we added to the Reinforcement Rate Model (and also to the Hyperbolic Discounting Model) an engagement function, f(p), that specified the likelihood the animal attends to a stimulus followed by reward with probability p, and then derived the model predictions for 2 forms of f(p), a linear function, and an all-or-none threshold function. Both models predicted the observed findings with a linear engagement function: The higher the probability of reinforcement after a stimulus, the higher the probability of engaging the stimulus, and, surprisingly, the less the value of the option comprising the stimulus. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde
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...
The uses of ionizing radiation in medicine are currently undergoing changes due to at least four major influences: (1) the constantly changing public perception of the hazards of radiation, (2) continuing technical innovation and development in equipment, (3) the imposition of diagnosis-related group funding by government health-care funding agencies, and (4) an increase in the average age of the U.S. population. The combined effect of these influences will probably result in a major increase in biplanar fluoroscopic examinations to support nonsurgical approaches such as percutaneous transluminal coronary angioplasty, percutaneous transluminal neuroembolism, and lithotripsy (the fracturing of kidney stones). As some of these examinations can result in 1.5 h of fluoroscopy, major doses to the patient and to the clinical staff can be expected. In addition, improved diagnostic techniques, such as using positron emission tomography (a combination of biochemistry and positron-emitting isotopes), can be expected to increase the number of small cyclotrons installed in medical centers. Counteracting these increases in radiation exposure is the development of digital radiography, which generally results in a lowering of the dose per diagnostic procedure. In the realm of therapeutic uses, one can expect higher-energy treatment accelerators, more patients being released from the hospital on therapeutic doses of isotopes, and a potential acceptance of neutron therapy as a cancer treatment modality. The latter treatment may take the form of boron capture therapy, 252Cf implant therapy, or external beam therapy using high-energy cyclotrons and the p,Be or the d,Be reaction to create the neutrons
depression and illness beliefs influence self-care behaviour. Keywords: Illness ... patients in Rwanda will provide new information on which to base further ... English, to facilitate the data collection process we used a translated version of the ...
Webb, Mary S; Passmore, Denise; Cline, Genieveve; Maguire, Denise
Currently preterm births are the leading causes of newborn deaths and newborn mortality in developed countries. Infants born prematurely remain vulnerable to many acute complications and long-term disabilities. There is a growing concern surrounding the moral and ethical implications of the complex and technological care being provided to extremely low birth weight infants in neonatal intensive care units in the developed nations. The purpose of this study was to describe the ethical and moral issues that neonatal intensive care nurses experience when caring for low birth weight preterm infants and their families. A phenomenological method design was used to describe the lived experiences of nurses with ethical and moral issues encountered in the neonatal intensive care unit. One-on-one, semi-structured interviews using open-ended questions were used to gather data from the participants. The setting for this study was a 97-bed neonatal intensive care. A total of 16 female nurses were interviewed. Approval to conduct the research study was obtained from the institutional review board of the hospital where the study was conducted. Formal signed consent was obtained from each participant. To ensure confidentiality, each participant was asked to choose a confederate name to be used in the interview and the transcriptions. The thematic analysis identified five recurring themes: (a) at the edge of viability, (b) infant pain and discomfort, (c) crucial decisions, (d) communicating with parents, and (e) letting go. Neonatal intensive care unit nurses indicated that they often had challenges to their own sense of morality as they struggled to protect the infant from pain and unnecessary discomfort, provide care to an infant and their family whom they thought was faced with a lifetime of challenges and poor health, accepting decisions made by parents, and feeling as if parents were not adequately informed about outcomes. © The Author(s) 2014.
Lindhardt, Tove; Nyberg, Per; Hallberg, Ingalill Rahm
Relatives are often involved in the care of frail elderly patients prior to admission and are thus important collaborative partners for nurses. They hold valuable knowledge, which may improve care planning for the benefit of the patient and the hospital care trajectory. Satisfaction among relatives may be an indicator of this. To investigate collaboration between relatives and nurses among those relatives reporting high versus low satisfaction with the hospital care trajectory. Further, the aim was to investigate the relationship between satisfaction with the hospital care trajectory and (i) participants' characteristics and (ii) the dimensions of collaboration. Relatives of elderly patients (n = 156) in acute hospital wards. Women constituted 74.8%, adult children 63.9% and spouses 20% of the participants. Mean age was 60.78 (SD 11.99). Cross-sectional, comparative, analytical. A self-report, structured questionnaire covering attributes, prerequisites, outcome and barriers/promoters for collaboration. Respondents reporting high versus low satisfaction were compared with regards to characteristics and mean scores in dimensions of collaboration. Multivariate logistic regression analyses examined predictors for satisfaction with the hospital care trajectory. Low satisfaction was significantly related to low level of collaboration. Other predictors for low satisfaction were: feelings of guilt and powerlessness, having provided help for less than a year and not providing psychosocial help. Satisfaction with care as a hypothesized outcome of collaboration was supported in this study. Hitherto, research has mainly focussed on relatives as potential clients; this study has focussed on relatives as competent collaborative partners in care. A new role for relatives as partners in decision-making rather than passive recipients of information is indicated for the benefit of care quality. Further, increased collaboration between relatives and nurses, assigning relatives
Nahm, Eun-Shim; Warren, Joan; Zhu, Shijun; An, Minjeong; Brown, Jeanine
Considerable research on preventive health care behaviors has been conducted in different segments of the population. Although nurses are the largest group of direct health care providers (3 million), little is known about their preventive health care behaviors. As the average age of nurses working in the United States (US) increases (mean age 47 years), maintaining their health to ensure they can continue to provide optimal health care to others becomes a greater priority. This descriptive online study examined registered nurses' dietary and exercise practices, weight status, stress levels, and preferred preventive health strategies using a sample of nurses recruited from a community-based, urban teaching hospital (n = 183; mean age 47 ± 11.3 years). The majority of participants (72.2%, n = 122) reported a lack of exercise, and more than half (53.8%, n = 91) had an irregular meal pattern. The average body mass index (BMI) was 28.3 ± 6.8, and 59.2% (n = 100) were either overweight (n = 47) or obese (n = 53). BMI had a significant inverse relationship with having a regular meal schedule and the amount of time spent exercising. Participants who reported greater stress had more irregular meal schedules. The most frequently used stress-release method was eating (n = 32), followed by exercise (n = 31). Nurses are fully aware of measures that should be taken for healthy living. Their knowledge, however, has not been well translated into their own self-care. As nursing shortages loom, maintaining the health of the aging nursing workforce is essential to retention. Further research is needed to identify factors that may motivate nurses to better care for themselves and measures that can be implemented by employers to initiate and sustain these preventive health care behaviors. Copyright © 2012 Elsevier Inc. All rights reserved.
Chen, Jie-Yu; Yang, Le-Bin; Jiang, Ping-Ping; Sun, Xiao-Min; Yu, Ke-Qiang; Li, Fei; Wu, Sheng-Wei; Ji, Yan-Zhao; Zhao, Xiao-Shan; Luo, Ren
To investigate associations between health-promoting lifestyle and suboptimal health status (SHS) in the population of Guangdong province. A cross-sectional survey was conducted in a clustered sample of 24 159 individuals aged 12-80 years from 2012 to 2013. Health-promoting lifestyle was assessed via the Health-Promoting Lifestyle Profile (HPLP-II), and SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0). Of the 24159 participants, subjects with SHS (46.0%) and disease status (35.2%) accounted for a much higher percentage than healthy subjects (18.8%). Regression analyses revealed a significant association between health status and healthy lifestyle (PUnhealthy lifestyle was an important risk factor for SHS and disease, especially the former. Compared with the participants with a healthy lifestyle (minimal exposure), after demographic adjustment, subjects with a 'poor' lifestyle (maximal exposure) were at a 43 times higher risk of developing SHS (OR: 42.825, 95% CI: 30.567-59.997), those with a general lifestyle were at a 21 times higher risk of SHS (OR: 21.072, 95%CI: 17.258-25.729), and those with a suboptimal lifestyle had a 4 times higher risk (OR: 4.085, 95%CI: 3.352-4.979). In the general population, the major risk factors for SHS included poor stress management, poor self-actualization, inactive exercise and poor interpersonal relationship. s Unhealthy lifestyles are significantly related to an increased risk of SHS. Intervention of unhealthy lifestyles, controlling the risk factors of SHS, and rigorous management of the time window of SHS are necessary to promote the heath status.
Jiamsakul, Awachana; Kumarasamy, Nagalingeswaran; Ditangco, Rossana; Li, Patrick CK; Phanuphak, Praphan; Sirisanthana, Thira; Sungkanuparph, Somnuek; Kantipong, Pacharee; Lee, Christopher KC; Mustafa, Mahiran; Merati, Tuti; Kamarulzaman, Adeeba; Singtoroj, Thida; Law, Matthew
Introduction Adherence to antiretroviral therapy (ART) plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh) in the first 24 months of ART in an Asian HIV cohort. Methods As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M) collected patients’ adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i) 14 days. Time was divided into four intervals: 0–6, 6–12, 12–18 and 18–24 months. Factors associated with SubAdh were analysed using generalized estimating equations. Results Out of 1316 patients, 32% ever reported 2 assessments per patient per year had an odds ratio (OR)=0.7 (95% confidence interval (CI) (0.55 to 0.90), p=0.006), compared to sites with ≤2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs) (OR=1.92, 95% CI (1.23 to 3.00), p=0.004) and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71), p<0.001). Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI) combination were less likely to report adherence <100% (OR=0.36, 95% CI (0.20 to 0.67), p=0.001) compared to patients taking an NRTI and non-nucleoside transcriptase inhibitor (NRTI+NNRTI) combination. SubAdh decreased with increasing time on ART (all p<0.001). Similar associations were found with adherence <95% as the outcome. Conclusions We found that SubAdh, defined as either <100% and <95%, was associated with mode of HIV exposure, ART regimen, time on ART and frequency of adherence measurement. The more frequently sites assessed patients, the lower the SubAdh, possibly reflecting site resourcing for patient counselling. Although social
Forry, Nicole D.; Hofferth, Sandra L.
With the passage of welfare reform, support for low-income parents to not only obtain but also maintain work has become imperative. The role of child care subsidies in supporting parents' job tenure has received little attention in the literature. This article examines the association between receiving a child care subsidy and experiencing a child…
Pols, J.; Pasveer, B.; Willems, D.
This paper articulates dignity as relational engagement in concrete care situations. Dignity is often understood as an abstract principle that represents inherent worth of all human beings. In actual care practices, this principle has to be substantiated in order to gain meaning and inform care
... Component members not in a present duty status. This authority includes payment for health care services in... 0790-AI52] Health Care Eligibility Under the Secretarial Designee Program and Related Special... establish policies and assign responsibilities for health care eligibility under the Secretarial Designee...
... Duty member. Additionally, with respect to care that is related to a non-covered initial surgery or... interest; namely, protecting former active duty members who have received private sector care pursuant to a... incorporated by reference for the benefits provided in the civilian health care sector to active duty family...
... members not in a present duty status. This authority includes payment for health care services in private... 0790-AI52 Health Care Eligibility Under the Secretarial Designee Program and Related Special... assigns responsibilities for health care eligibility under the Secretarial Designee Program. It also...
The most important development in the health care sector in the Netherlands over the past five years had been the introduction and development of market regulation. Unions are critical of this development and point at contraproductive effects of specialisation and large scale companies. Employers
Spatenkova, Vera; Bradac, Ondrej; de Lacy, Patricia; Skrabalek, Pavel
Polyuria has the potential to cause severe water and sodium imbalance. We studied the epidemiology of polyuria in association with dysnatraemias and whether polyuria is an independent risk factor for higher mortality and poorer outcome in neurocritical care. We performed an analysis of a 3-year prospective database containing 902 neurocritical care patients. Polyuria was defined as diuresis above 4000 ml/day, hyponatraemia as a serum sodium (SeNa) 150 mmol/l. We identified polyuria in 236 (26.2%) patients (639 days). Polyuric patients stayed in the neurointensive care unit (NICU) longer than those without polyuria (mean: 10.7 vs. 3.5 days, p polyuria (p polyuria in 7 (3.0%) patients and central diabetes insipidus (CDI) in another 5 (2.1%) patients. Univariate models showed polyuria to be a risk factor for poor outcome (odds ratio [OR] = 1.39, p = 0.032) and had a borderline significance for mortality during their NICU stay (OR = 1.83, p = 0.055). These factors did not appear as significant following multivariate logistic regression analysis. Polyuria often occurred in neurocritical care patients, but was not usually associated with sodium imbalance, CSW or CDI. We did not find that polyuria was a significant predictor of increased mortality or poorer outcome in NICU patients.
Full Text Available Abstract Background Antiretroviral therapy (ART partially corrects immune dysfunction associated with HIV infection. The levels of T-cell immune activation and exhaustion after long-term, suppressive ART and their correlation with CD4 T-cell count reconstitution among ART-treated patients in African cohorts have not been extensively evaluated. Methods T-cell activation (CD38+HLA-DR+ and immune exhaustion (PD-1+ were measured in a prospective cohort of patients initiated on ART; 128 patient samples were evaluated and subcategorized by CD4 reconstitution after long-term suppressive treatment: Suboptimal [median CD4 count increase 129 (-43-199 cells/μl], N = 34 ], optimal [282 (200-415 cells/μl, N = 64] and super-optimal [528 (416-878 cells/μl, N = 30]. Results Both CD4+ and CD8 T-cell activation was significantly higher among suboptimal CD4 T-cell responders compared to super-optimal responders. In a multivariate model, CD4+CD38+HLADR+ T-cells were associated with suboptimal CD4 reconstitution [AOR, 5.7 (95% CI, 1.4-23, P = 0.014]. T-cell exhaustion (CD4+PD1+ and CD8+PD1+ was higher among suboptimal relative to optimal (P P = 0.022]. Conclusion T-cell activation and exhaustion persist among HIV-infected patients despite long-term, sustained HIV-RNA viral suppression. These immune abnormalities were associated with suboptimal CD4 reconstitution and their regulation may modify immune recovery among suboptimal responders to ART.
Full Text Available Abstract Background HIV/AIDS is fast becoming a chronic disease with the advent of antiretroviral drugs, therefore making home based care key in the management of chronically ill HIV/AIDS patient. The objective of this study was to determine the perception and practice of health care workers on HIV/AIDS related home based care in the health facilities in Ogun state, Nigeria. Methods This study is an analytical cross-sectional study. A multistage cluster sampling technique was used to obtain a representative sample of the primary health care workers in Ogun state. An interviewer administered structured questionnaire was administered by trained health workers to elicit the required information. Result A total of 350 health care workers were interviewed, 70% of the respondents could adequately describe the components of home based care. Only 38.7% were aware of the National guideline on home based care practices and 17.1% believe that home based care will not significantly improve the prognosis of PLWAs. Few 19.1% had ever been trained or ever involved 16.6% in home based care practices. Only 20 [5.7%] are involved on a weekly basis, 16 [4.6%] monthly and 22 [6.3%] quarterly. Reasons given for non implementation of home based care are inadequate number of healthcare workers 45%, lack of political will 24.4%, lack of implementation by facility managers 14% and inadequate funds 16.6%. Factors that were significantly associated with the practice of home based care were perception of its relevance in improving prognosis [OR = 54.21, C.I = 23.22-129.52] and presence of a support group in the facility [OR = 4.80, C.I = 2.40-9.57]. There was however no statistically significant relationship between adequate knowledge of home based care [OR = 0.78, C.I = 0.39-1.54] and previous training on home based care (OR = 1.43, C.I = 0.66-3.06]. Conclusion The practice of home based care for HIV/AIDS among the study population is low
Courvoisier, Delphine S; Cullati, Stéphane; Haller, Chiara S; Schmidt, Ralph E; Haller, Guy; Agoritsas, Thomas; Perneger, Thomas V
Regret after one of the many decisions and interventions that health care professionals make every day can have an impact on their own health and quality of life, and on their patient care practices. To validate a new care-related regret intensity scale (RIS) for health care professionals. Retrospective cross-sectional cohort study with a 1-month follow-up (test-retest) in a French-speaking University Hospital. A total of 469 nurses and physicians responded to the survey, and 175 answered the retest. RIS, self-report questions on the context of the regret-inducing event, its consequences for the patient, involvement of the health care professionals, and changes in patient care practices after the event. We measured the impact of regret intensity on health care professionals with the satisfaction with life scale, the SF-36 first question (self-reported health), and a question on self-esteem. On the basis of factor analysis and item response analysis, the initial 19-item scale was shortened to 10 items. The resulting scale (RIS-10) was unidimensional and had high internal consistency (α=0.87) and acceptable test-retest reliability (0.70). Higher regret intensity was associated with (a) more consequences for the patient; (b) lower life satisfaction and poorer self-reported health in health care professionals; and (c) changes in patient care practices. Nurses reported analyzing the event and apologizing, whereas physicians reported talking preferentially to colleagues, rather than to their supervisor, about changing practices. The RIS is a valid and reliable measure of care-related regret intensity for hospital-based physicians and nurses.
As a result of restructuring, home care is increasingly defined in a narrow, task-based way, undermining the holistic nature of practice. Recent practice theories can aid us in articulating the nature of this important, yet often invisible practice. My aim in this article was to enhance our knowledge and understanding of the nature of home care nursing practice. The approach was ethnographic, involving extensive fieldwork and formal interviews with members of five home care nursing teams and 15 older persons receiving care at home in a metropolitan area of Iceland. The study was approved by the National Bioethics Committee. As a net of services, home care was enacted through relational, but often invisible care practices, relating different actors - patient, family and health-care and social-care workers - in doing the work needed for the older persons to live comfortably at home. The work was collective in that it was shared by different actors and motivated by a common understanding that had developed and was preserved in conversations in the teams. Although the findings are limited in that they only reflect home care as practiced in one neighbourhood, they can be seen as providing important insights into what is needed for home care services to work. Home care practice can be understood as relational, aimed at creating a net of needed assistance. This work is a collective accomplishment of the teams and shaped by ideals and values shared among team members. © 2017 Nordic College of Caring Science.
Kawaguchi, S; Mirza, R; Nissim, R; Ridley, J
Internal medicine residents are frequently called upon to provide palliative care to hospitalized patients, but report feeling unprepared to do so effectively. Curricular development to enhance residents' palliative care skills and competencies requires an understanding of current beliefs, attitudes and learning priorities. We conducted a qualitative study consisting of semi-structured interviews with ten internal medicine residents to explore their understanding of and experiences with palliative care. All of the residents interviewed had a sound theoretical understanding of palliative care, but faced many challenges in being able to provide care in practice. The challenges described by residents were system-related, patient-related and provider-related. They identified several priority areas for further learning, and discussed ways in which their current education in palliative care could be enhanced. Our findings provide important insights to guide curricular development for internal medicine trainees. The top five learning priorities in palliative care that residents identified in our study were: 1) knowing how and when to initiate a palliative approach, 2) improving communication skills, 3) improving symptom management skills, 4) identifying available resources, and 5) understanding the importance of palliative care. Residents felt that their education in palliative care could be improved by having a mandatory rotation in palliative care, more frequent didactic teaching sessions, more case-based teaching from palliative care providers, opportunities to be directly observed, and increased support from palliative care providers after-hours.
Suellen Karina de Oliveira Giroti
Full Text Available Objective: to analyze the introduction of the theme infections associated to health care in nurses’ education. Methods: this is a qualitative study, with documentary analysis of 16 interdisciplinary modules of a nursing integrated curriculum from a State University in Paraná, conducted in 2013. Results: in the first year of the course there were no references to infections. From the second to the fourth years there were 44 entries that approached: hand washing, actions to prevent infections in newborns, children, adults, pregnant women and surgical patients in different health environments, biosecurity, Regulatory Standard n. 32, dental-medical-hospital supplies processing, among others. One highlighted strengths and flaws on the approach of this theme in many moments of an integrated curriculum. Conclusion: the infections associated to health care, given their relevance and complexity, should be introduced in a transversal and continuous way in nurse’s education, providing nursing students with a reflexive and critical learning.
In conclusion, among adult ever users of marijuana, current tobacco use is high and strongly associated with suboptimal SRH; regular marijuana smoking with or without current tobacco use is significantly associated with suboptimal SRH.
In animal care, 40.0%, 31.3%, 30.0%, 12.5%, 7.5% and 5.0% were of the opinion that cattle could be respectively tired, hungry, sick, heady, injured and being in a strange environment might be the reasons for their refusal to obey the instruction of the handlers. In controlling the cattle for a direction, 85.7%, 10.4% and 3.9% ...
Suellen Karina de Oliveira Giroti; Mara Lucia Garanhani
Objective: to analyze the introduction of the theme infections associated to health care in nurses’ education. Methods: this is a qualitative study, with documentary analysis of 16 interdisciplinary modules of a nursing integrated curriculum from a State University in Paraná, conducted in 2013. Results: in the first year of the course there were no references to infections. From the second to the fourth years there were 44 entries that approached: hand washing, actions to prevent infections i...
Antonio Olivera-La Rosa
Full Text Available Previous research has identified a set of core factors that influence moral judgments. The present study addresses the interplay between moral judgments and four factors: (a incidental affects, (b sociocultural context, (c type of dilemma, and (d participant's sex. We asked participants in two different countries (Colombia and Spain to judge the acceptability of actions in response to personal and impersonal moral dilemmas. Before each dilemma an affective prime (erotic, pleasant or neutral pictures was presented suboptimally. Our results show that: a relative to neutral priming, erotic primes increase the acceptance of harm for a greater good (i.e., more utilitarian judgments, b relative to Colombians, Spanish participants rated causing harm as less acceptable, c relative to impersonal dilemmas, personal dilemmas reduced the acceptance of harm, and d relative to men, women were less likely to consider harm acceptable. Our results are congruent with findings showing that sex is a crucial factor in moral cognition, and they extend previous research by showing the interaction between culture and incidental factors in the making of moral judgments.
Olivera-La Rosa, Antonio; Corradi, Guido; Villacampa, Javier; Martí-Vilar, Manuel; Arango, Olber Eduardo; Rosselló, Jaume
Previous research has identified a set of core factors that influence moral judgments. The present study addresses the interplay between moral judgments and four factors: (a) incidental affects, (b) sociocultural context, (c) type of dilemma, and (d) participant's sex. We asked participants in two different countries (Colombia and Spain) to judge the acceptability of actions in response to personal and impersonal moral dilemmas. Before each dilemma an affective prime (erotic, pleasant or neutral pictures) was presented suboptimally. Our results show that: a) relative to neutral priming, erotic primes increase the acceptance of harm for a greater good (i.e., more utilitarian judgments), b) relative to Colombians, Spanish participants rated causing harm as less acceptable, c) relative to impersonal dilemmas, personal dilemmas reduced the acceptance of harm, and d) relative to men, women were less likely to consider harm acceptable. Our results are congruent with findings showing that sex is a crucial factor in moral cognition, and they extend previous research by showing the interaction between culture and incidental factors in the making of moral judgments.
Magán, Purificación; Alberquilla, Angel; Otero, Angel; Ribera, José Manuel
Hospitalizations for ambulatory care sensitive conditions (ACSH) have been proposed as an indirect indicator of the effectiveness and quality of care provided by primary health care. To investigate the association of ACSH rates with population socioeconomic factors and with characteristics of primary health care. Cross-sectional, ecologic study. Using hospital discharge data, ACSH were selected from the list of conditions validated for Spain. All 34 health districts in the Region of Madrid, Spain. Individuals aged 65 years or older residing in the region of Madrid between 2001 and 2003, inclusive. Age- and gender-adjusted ACSH rates in each health district. The adjusted ACSH rate per 1000 population was 35.37 in men and 20.45 in women. In the Poisson regression analysis, an inverse relation was seen between ACSH rates and the socioeconomic variables. Physician workload was the only health care variable with a statistically significant relation (rate ratio of 1.066 [95% CI; 1.041-1.091]). These results were similar in the analyses disaggregated by gender. In the multivariate analyses that included health care variables, none of the health care variables were statistically significant. ACSH may be more closely related with socioeconomic variables than with characteristics of primary care activity. Therefore, other factors outside the health system must be considered to improve health outcomes in the population.
Hathaway, Elizabeth E.; Luberto, Christina M.; Bogenschutz, Lois H.; Geiss, Sue; Wasson, Rachel S.; Cotton, Sian
Background: Pain management is a frequent problem in the neonatal intensive care unit (NICU). Few studies examining effects of integrative care therapies on pain-related outcomes in neonates have included physiological outcomes or investigated the use of such therapies in a practice-based setting. Objective: The purpose of this practice-based retrospective study was to examine the associations between integrative care therapies, particularly massage and healing touch, and pain-related outcome...
Jaleel, Hassan; Shamma, Jeff S.
of establishing a communication link between two base stations with minimum energy consumption. We show through simulations that the performance under the proposed framework is close to the optimal performance and the suboptimal policy can be efficiently
Masahiko Umei, MD
Conclusions: With good adherence, the clinical course associated with DOACs is comparatively good. In the future, suboptimal low-dose DOAC therapy may serve as an appropriate choice for some patients with a high risk of stroke and bleeding.
Man, Ryan Eyn Kidd; Li, Ling-Jun; Cheng, Ching-Yu; Wong, Tien Yin; Lamoureux, Ecosse; Sabanayagam, Charumathi
This population-based cross-sectional study examined the prevalence and risk factors of suboptimal vitamin D levels (assessed using circulating 25-hydroxycholecalciferol (25(OH)D)) in a multi-ethnic sample of Asian adults. Plasma 25(OH)D concentration of 1139 Chinese, Malay and Indians (40-80 years) were stratified into normal (≥30 ng/mL), and suboptimal (including insufficiency and deficiency, 65 years), Malay and Indian ethnicities (compared to Chinese ethnicity), and higher body mass index, HbA1c, education and income levels were associated with suboptimal 25(OH)D concentration ( p < 0.05). In a population-based sample of Asian adults, approximately 75% had suboptimal 25(OH)D concentration. Targeted interventions and stricter reinforcements of existing guidelines for vitamin D supplementation are needed for groups at risk of vitamin D insufficiency/deficiency.
Original Research: Sub-Optimal Management of Type 2 Diabetes Mellitus – A Local Audit ... despite clinical trial data documenting improved outcomes associated not ... were used to define the Metabolic Syndrome.9 Central obesity was.
Seo, Bo Kyeong
Drawing on fieldwork in a neonatal intensive care unit (NICU) in Chiang Mai during 2010 and 2012, I examine neonatal care as a contingent entanglement of technological and ethical relationships with vulnerable others. Along the continuum of universal antenatal and delivery care, neonatal medicine becomes a normative part of reproductive health care in Chiang Mai. As the NICU opens its door to sick newborns whose belonging to kinship and the nation-state is uncertain, neonatal care requires deliberate practices to incorporate them into life-sustaining connections. By tracing medical staff's effort to be accountable to their fragile patients, I show that withdrawing of intensive care is relational work that requires affective involvement and distancing through commensality, prosthetic extensions, and karmic network. This specific mode of care, which is premised on the combination of unconditional openness and careful detachment, offers insight into a possible enactment of hospitality within biomedical institutions.
Bouman, Zita; Hendriks, Marc PH; Schmand, Ben A; Kessels, Roy PC; Aldenkamp, Albert
Introduction. Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the identification of suboptimal performance using an analogue study design. Method. The patient group consisted of 59 mixed-etiology patients; the experimental malingerers were 50 healthy individuals...
Bouman, Zita; Hendriks, Marc P.H.; Schmand, Ben A.; Kessels, Roy P.C.; Aldenkamp, Albert P.
Introduction. Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the identification of suboptimal performance using an analogue study design.Method. The patient group consisted of 59 mixed-etiology patients; the experimental malingerers were 50 healthy individuals who ...
The victim impact statement (VIS) is a written account of harms experienced as a result of crime. This study investigates VIS use by sexually assaulted women through interviews with Canadian victims, victim services workers, and feminist advocates (N = 35). Findings suggest that victims use the VIS to express relational caring. Relational caring is an ethic of care that prioritizes others through privileging the harms experienced by others because of witnessing the sexual assault or coping with the victim's postassault sequelae, protecting future or hypothetical victims, and promoting the interests of intimate partner offenders. Relational caring challenges traditional conceptions of victim agency and VIS use for instrumental purposes, as well as the targets and temporalities of sexual assault harms that are detailed in the statement. Relational caring has unique implications for victims who are mothers, especially those abused as minors, and for intimate partners. Legal, therapeutic, and social service consequences are discussed.
Huber, Evelyn; Kleinknecht-Dolf, Michael; Müller, Marianne; Kugler, Christiane; Spirig, Rebecca
To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire. The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is necessary, given the increased significance of the topic, due to shortened lengths of stay and increased patient morbidity. Hybrid model of concept development and embedded mixed-methods design. The theoretical phase of the hybrid model involved a literature review and the development of a working definition. In the fieldwork phase of 2015 and 2016, an embedded mixed-methods design was applied with complexity assessments of all patients at five Swiss hospitals using our newly operationalized questionnaire 'Complexity of Nursing Care' over 1 month. These data will be analysed with structural equation modelling. Twelve qualitative case studies will be embedded. They will be analysed using a structured process of constructing case studies and content analysis. In the final analytic phase, the quantitative and qualitative data will be merged and added to the results of the theoretical phase for a common interpretation. Cantonal Ethics Committee Zurich judged the research programme as unproblematic in December 2014 and May 2015. Following the phases of the hybrid model and using an embedded mixed-methods design can reach an in-depth understanding of patient-related complexity of nursing care in acute care hospitals, a final version of the questionnaire and an acknowledged definition of the concept. © 2016 John Wiley & Sons Ltd.
Uijen, Annemarie A; Schers, Henk J; Schellevis, François G; van den Bosch, Wil J H M
The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. In order to clarify the confusion of tongues and to identify core values of these patient-centred concepts, we provide a historical overview of continuity of care and four related concepts: coordination of care, integration of care, patient-centred care and case management. We identified and reviewed articles including a definition of one of these concepts by performing an extensive literature search in PubMed. In addition, we checked the definition of these concepts in the Oxford English Dictionary. Definitions of continuity, coordination, integration, patient-centred care and case management vary over time. These concepts show both great entanglement and also demonstrate differences. Three major common themes could be identified within these concepts: personal relationship between patient and care provider, communication between providers and cooperation between providers. Most definitions of the concepts are formulated from the patient's perspective. The identified themes appear to be core elements of care to patients. Thus, it may be valuable to develop an instrument to measure these three common themes universally. In the patient-centred medical home, such an instrument might turn out to be an important quality measure, which will enable researchers and policy makers to compare care settings and practices and to evaluate new care interventions from the patient perspective.
Ausili, Davide; Masotto, Matteo; Dall'Ora, Chiara; Salvini, Lorena; Di Mauro, Stefania
Chronic illnesses care represents a challenging issue for people well-being and future health systems' sustainability. Promotion of self-care is considered a key point for chronically ill patients' care. The aim of this literature was to explore: how self-care of chronic illness has been theoretically defined; how self-care can be assessed in clinical and research settings; what associations exist between self-care and health outcomes of chronically ill patients. A wide range of definitions and terminologies related to self-care of chronic illness has been found in the literature. Although some common elements useful to explain the concept of self-care have been identified, the physical, cognitive, emotional and social processes underlying self-care remain controversial and poorly defined. Valid and reliable disease-specific assessment tools have been developed and used in a growing number of studies; however, the lack of utilization of standardized instruments in clinical practice has been referred by many authors. Significant correlations between self-care of chronic illness and outcome measures e.g. general health status, quality of life and healthcare costs, are reported by a limited number of studies. Supporting patient self-care is recognized as a crucial factor in chronic illness care. A deeper analysis of variables and processes influencing self-care could help for a full description of the phenomenon. A systematic evaluation of self-care in health professionals' everyday clinical practice is strongly recommended. The development of general non-disease-specific assessment tools could facilitate the evaluation of complex patients, especially those with multiple co-morbidities. Although self-care has been recognized as a vital intermediate outcome, further large-scale studies clarifying the association between self-care and patients' and health systems' outcomes are needed.
Strang, Cecily W; Mixer, Sandra J
Although malaria is preventable and treatable, morbidity and mortality from this disease continue among the Maasai of Southern Kenya. Prior to this study, the Maasai's generic and professional malaria care/cure practices were largely unknown. The purpose of this study was to discover, describe, and systematically analyze meanings, expressions, and practices that promote culturally congruent malaria care among this population. The qualitative, ethnonursing research method was used to conduct in-depth examination of the Maasai ethnohistory and culture relevant to malaria care and analyze data from 48 interviews conducted in Maasailand. Guided by the "culture care theory," four themes were discovered related to Maasai community, traditional, spiritual, and professional care/cure practices. These significant findings filled a research gap and contribute to nursing knowledge and caring practice. These study findings have implications for culturally congruent malaria care education, practice, research, policy, and partnership with traditional and professional caregivers. © The Author(s) 2015.
Lemola, Sakari; Meyer-Leu, Yvonne; Samochowiec, Jakub; Grob, Alexander
Smoking during pregnancy is one of the most important avoidable health risks for the unborn child. Gynaecologists and midwives play a fundamental role in the prevention of smoking during pregnancy. However, a large number of health care practitioners still do not address smoking in pregnant patients. We examined whether gynaecologists and midwives engage in screening and counselling of pregnant women and conducting interventions to prevent smoking during pregnancy. Further, we examined the role of gynaecologists' and midwives' control beliefs. Control beliefs involve efficacy expectations--the practitioner's confidence in his capacity to conduct prevention efforts adequately--and outcome expectations--the practitioner's expectation that such prevention efforts are successful in general. A total of 486 gynaecologists and 366 midwives completed a questionnaire on screening of smoking, counselling and other interventions they conduct to prevent smoking during pregnancy. Moreover, gynaecologists and midwives rated their control beliefs regarding their influence on pregnant patients' smoking habits. The majority of gynaecologists and midwives reported screening all pregnant patients regarding smoking, explaining the risks and recommending smoking cessation. By contrast, only a minority engages in more extensive prevention efforts. Strong control beliefs were predictive of a higher likelihood of screening and counselling, as well as of engaging in more extensive interventions. The findings point to the importance of strengthening gynaecologists' and midwives' control beliefs by professional education and training on smoking prevention. © 2012 John Wiley & Sons Ltd.
with community clinics for injecting drug-dependent persons is also being implemented. Shared care models require oversight to ensure that primary responsibility is defined for the persons overall health situation, for screening of co-morbidities, defining indication to treat comorbidities, prescription of non......Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good...... outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining...
Palombini, Analice de Lima; Onocko-Campos, Rosana Teresa; Silveira, Marília; Gonçalves, Laura Lamas Martins; Zanchet, Lívia; Xavier, Maria Angélica Zamora; de Castro e Marques, Cecília
This paper is derived from the experience of conducting research with mental health users (not about them, nor for them), analyzing aspects of a study in which different ways of structuring the relationship between clinical practice and research were put into play, thereby questioning the boundaries and ethical issues involved. The clinical practice and research fields that are dealt with are studied with the input of authors who, on the basis of institutional analysis, propose the idea of interventional research, and in the context of public health, revert to the concept of broadened clinical care. The relationship between these two terms - interventional research and broadened clinical care - is based on the notion of subjectivity that operates within the scope of public health and which culminates in the concept of autonomy. Lastly, co-management is proposed as a strategy based on which the different actors involved in conducting research and exercising clinical care can collectively build working principles that are both therapeutic and ethical.
Ettelt, S; Nolte, E
This report reviews approaches to funding intensive care in health systems that use activitybased payment mechanisms based on diagnosis-related groups (DRGs) to reimburse hospital care. The report aims to inform the current debate about options for funding intensive care services for adults, children and newborns in England. Funding mechanisms reviewed here include those in Australia (Victoria), Denmark, France, Germany, Italy, Spain, Sweden and the United States (Medicare). Approaches to org...
stages of psychosocial development , intimacy versus isolation, generativity versus...1983) eluded can be related to one’s attempt to master the psychosocial stages of development utilizing Erikson’s psychosocial stages of development ...early adulthood one must work through Erikson’s stage of 9 intimacy versus isolation. It is during this stage that one develops "the capacity
Rubenstein, Lisa V; Danz, Marjorie S; Crain, A Lauren; Glasgow, Russell E; Whitebird, Robin R; Solberg, Leif I
Depression is a major cause of morbidity and cost in primary care patient populations. Successful depression improvement models, however, are complex. Based on organizational readiness theory, a practice's commitment to change and its capability to carry out the change are both important predictors of initiating improvement. We empirically explored the links between relative commitment (i.e., the intention to move forward within the following year) and implementation capability. The DIAMOND initiative administered organizational surveys to medical and quality improvement leaders from each of 83 primary care practices in Minnesota. Surveys preceded initiation of activities directed at implementation of a collaborative care model for improving depression care. To assess implementation capability, we developed composites of survey items for five types of organizational factors postulated to be collaborative care barriers and facilitators. To assess relative commitment for each practice, we averaged leader ratings on an identical survey question assessing practice priorities. We used multivariable regression analyses to assess the extent to which implementation capability predicted relative commitment. We explored whether relative commitment or implementation capability measures were associated with earlier initiation of DIAMOND improvements. All five implementation capability measures independently predicted practice leaders' relative commitment to improving depression care in the following year. These included the following: quality improvement culture and attitudes (p = 0.003), depression culture and attitudes (p commitment (p = 0.002) and prior depression quality improvement activities appeared to be associated with earlier participation in the DIAMOND initiative. The study supports the concept of organizational readiness to improve quality of care and the use of practice leader surveys to assess it. Practice leaders' relative commitment to depression care
Johnsen, Anna T; Ross, Lone; Petersen, Morten A
In order to improve advanced cancer care, evaluations are necessary. An important element of such evaluations is the perspective of the patient's relatives who have the role of being caregivers as well as co-users of the health care system. The aims were to investigate the scale structure of the ...
Tucker, Larry A.; Clegg, Alan G.
Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…
... wellness services and chronic disease management; and pediatric services, including oral \\8\\ and vision... Act uses the terms ``dental'' and ``oral'' interchangeably when referring to the pediatric dental care... Parts 147, 155, and 156 Patient Protection and Affordable Care Act; Standards Related to Essential...
Francesca S. M. Tang
Full Text Available Background. Respiratory infections are a major cause of asthma exacerbations where neutrophilic inflammation dominates and is associated with steroid refractory asthma. Structural airway cells in asthma differ from nonasthmatics; however it is unknown if neutrophils differ. We investigated neutrophil immune responses in patients who have good (AGood and suboptimal (ASubopt asthma symptom control. Methods. Peripheral blood neutrophils from AGood (ACQ 0.75, n=7, and healthy controls (HC (n=9 were stimulated with bacterial (LPS (1 μg/mL, fMLF (100 nM, and viral (imiquimod (3 μg/mL, R848 (1.5 μg/mL, and poly I:C (10 μg/mL surrogates or live rhinovirus (RV 16 (MOI1. Cell-free supernatant was collected after 1 h for neutrophil elastase (NE and matrix metalloproteinase- (MMP- 9 measurements or after 24 h for CXCL8 release. Results. Constitutive NE was enhanced in AGood neutrophils compared to HC. fMLF stimulated neutrophils from ASubopt but not AGood produced 50% of HC levels. fMLF induced MMP-9 was impaired in ASubopt and AGood compared to HC. fMLF stimulated CXCL8 but not MMP-9 was positively correlated with FEV1 and FEV1/FVC. ASubopt and AGood responded similarly to other stimuli. Conclusions. Circulating neutrophils are different in asthma; however, this is likely to be related to airflow limitation rather than asthma control.
Objective Up to 50% of pregnancies are unintended in the United States, and the healthcare costs associated with pregnancy are the most expensive among hospitalized conditions. The current study aims to assess Medicaid spending on various methods of contraception and on pregnancy care including unintended pregnancies. Methods We analyzed Medicaid health claims data from 2004 to 2010. Women 14–49 years of age initiating contraceptive methods and pregnant women were included as separate cohorts. Medicaid spending was summarized using mean all-cause and contraceptive healthcare payments per patient per month (PPPM) over a follow-up period of up to 12 months. Medicaid payments were also estimated in 2008 per female member of childbearing age per month (PFCPM) and per member per month (PMPM). Medicaid payments on unintended pregnancies were also evaluated PFCPM and PMPM in 2008. Results For short-acting reversible contraception (SARC) users, all-cause payments and contraceptive payments PPPM were respectively $365 and $18.3 for oral contraceptive (OC) users, $308 and $19.9 for transdermal users, $215 and $21.6 for vaginal ring users, and $410 and $8.8 for injectable users. For long-acting reversible contraception (LARC) users (follow-up of 9–10 months), corresponding payments were $194 and $36.8 for IUD users, and $237 and $29.9 for implant users. Pregnancy cohort all-cause mean healthcare payments PPPM were $610. Payments PFCPM and PMPM for contraceptives were $1.44 and $0.54, while corresponding costs of pregnancies were estimated at $39.91 and $14.81, respectively. Payments PFCPM and PMPM for contraceptives represented a small fraction at 6.56% ($1.44/$21.95) and 6.63% ($0.54/$8.15), respectively of the estimated payments for unintended pregnancy. Conclusions This study of a large sample of Medicaid beneficiaries demonstrated that, over a follow-up period of 12 months, Medicaid payments for pregnancy were considerably higher than payments for either SARC or
Rosenthal, Elana S; Karchmer, Adolf W; Theisen-Toupal, Jesse; Castillo, Roger Araujo; Rowley, Chris F
Infective endocarditis is a serious infection, often resulting from injection drug use. Inpatient treatment regularly focuses on management of infection without attention to the underlying addiction. We aimed to determine the addiction interventions done in patients hospitalized with injection drug use-associated infective endocarditis. This is a retrospective review of patients hospitalized with injection drug use-associated infective endocarditis from January, 2004 through August, 2014 at a large academic tertiary care center in Boston, Massachusetts. For the initial and subsequent admissions, data were collected regarding addiction interventions, including consultation by social work, addiction clinical nurse and psychiatry, documentation of addiction in the discharge summary plan, plan for medication-assisted treatment and naloxone provision. There were 102 patients admitted with injection drug use-associated infective endocarditis, 50 patients (49.0%) were readmitted and 28 (27.5%) patients had ongoing injection drug use at readmission. At initial admission, 86.4% of patients had social work consultation, 23.7% had addiction consultation, and 24.0% had psychiatry consultation. Addiction was mentioned in 55.9% of discharge summary plans, 7.8% of patients had a plan for medication-assisted treatment, and naloxone was never prescribed. Of 102 patients, 26 (25.5%) are deceased. The median age at death was 40.9 years (interquartile range 28.7-48.7). We found that patients hospitalized with injection drug use-associated infective endocarditis had high rates of readmission, recurrent infective endocarditis and death. Despite this, addiction interventions were suboptimal. Improved addiction interventions are imperative in the treatment of injection drug use-associated infective endocarditis. Copyright © 2016 Elsevier Inc. All rights reserved.
LaVela, Sherri L; Heinemann, Allen W; Etingen, Bella; Miskovic, Ana; Locatelli, Sara M; Chen, David
Describe perceptions of persons with SCI on their receipt of holistic care and relational empathy during health care encounters. Mailed survey. Individuals with SCI who received care from the largest suppliers of SCI care and rehabilitation (Veterans Health Administration and SCI Model Systems). Using a survey and administrative databases, we collected demographic and injury characteristics, health status, health conditions, and the main outcome: Consultation and Relational Empathy (CARE) measure. The sample included 450 individuals with SCI (124 Veterans and 326 civilians). Response rate was 39% (450/1160). Analyses were conducted on patients with complete data (n = 389). Veterans and civilians with SCI differed across many demographic characteristics, age at injury, and etiology, but mean CARE scores were equivalent. Fewer than half of the full SCI cohort had CARE scores above the normative value of 43. Having a recent pressure ulcer showed a trend for lower odds of having a normative or higher CARE score. Odds of having an above-normative CARE score were nearly 2 times greater for individuals with tetraplegia, and odds were higher for those with higher physical and mental health status. Higher physical and mental health status and tetraplegia were each independently associated with greater perceptions of holistic care and empathy in the therapeutic patient-provider relationship. Limited empathy, communication, and holistic care may arise when providers focus on disease/disease management, rather than on patients as individuals. Frequent health care use and secondary conditions may affect empathy and holistic care in encounters, making it essential to understand and employ efforts to improve the therapeutic relationship between patients with SCI and their providers.
Shaffer, Anne; Lindhiem, Oliver; Kolko, David
The goal of this brief report is to demonstrate the utility of quantifying parental discipline practices as relative frequencies in measuring changes in parenting behavior and relations to child behavior following intervention. We explored comparisons across methodological approaches of assessing parenting behavior via absolute and relative frequencies in measuring improvements in parent-reported disciplinary practices (increases in positive parenting practices in response to child behavior; decreases in inconsistent discipline and use of corporal punishment) and child behavior problems. The current study was conducted as part of a larger clinical trial to evaluate the efficacy of a collaborative care intervention for behavior problems, ADHD, and anxiety in pediatric primary care practices (Doctor Office Collaborative Care; DOCC). Participants were 321 parent-child dyads (M child age = 8.00, 65 % male children) from eight pediatric practices that were cluster randomized to DOCC or enhanced usual care (EUC). Parents reported on their own discipline behaviors and child behavior problems. While treatment-related decreases in negative parenting were found using both the absolute and relative frequencies of parenting behaviors, results were different for positive parenting behaviors, which showed decreases when measured as absolute frequencies but increases when measured as relative frequencies. In addition, positive parenting was negatively correlated with child behavior problems when using relative frequencies, but not absolute frequencies, and relative frequencies of positive parenting mediated relations between treatment condition and outcomes. Our findings indicate that the methods used to measure treatment-related change warrant careful consideration.
Gulmans, J.; Gulmans, J.; Vollenbroek-Hutten, Miriam Marie Rosé; van Gemert-Pijnen, Julia E.W.C.; van Harten, Willem H.
Background. Owing to the involvement of multiple professionals from various institutions, integrated care settings are prone to suboptimal patient care communication. To assure continuity, communication gaps should be identified for targeted improvement initiatives. However, available assessment
Shetgiri, Rashmi; Lin, Hua; Flores, Glenn
This study examines associations between maternal and paternal mental health and child bullying perpetration among school-age children, and whether having one or both parents with suboptimal mental health is associated with bullying. The 2007 National Survey of Children's Health, a nationally-representative, random-digit-dial survey, was analyzed, using a parent-reported bullying measure. Suboptimal mental health was defined as fair/poor (vs. good/very good/excellent) parental self-reported mental and emotional health. Of the 61,613 parents surveyed, more than half were parents of boys and were white, 20% were Latino, 15% African American, and 7% other race/ethnicity. Suboptimal maternal (OR 1.4; 95% CI 1.1-1.8) and paternal (OR 1.5; 95% CI 1.1-2.2) mental health are associated with bullying. Compared with children with no parents with suboptimal mental health, children with only one or both parents with suboptimal mental health have higher bullying odds. Addressing the mental health of both parents may prove beneficial in preventing bullying.
Zang, Yu-Li; Chung, Loretta Y F; Wong, Thomas K S; Chan, Moon Fai
To discover the latent psychosocial construct of female nurses' sensitivity to male genitalia-related care in the context of sexual conservativeness. Many nursing activities involve direct exposure or contact with male external genitalia. In the sexually conservative culture and the predominance of female nurses, this area is the subject of continuing interest and investigation. Methodological research design. An item pool related to male genitalia-related care was generated through a panel of experts and then reduced to a short form questionnaire, the Female Nurses' Sensitivity to Male Genitalia Related Care scale. Using data from a purposive sample of 588 female nurses, the structure of the questionnaire was examined using structural equation modelling. The validity was examined against existing scales. The 13-item Female Nurses' Sensitivity to Male Genitalia Related Care scale has a two-factor structure with high internal consistency (α = 0·87) and test-retest reliability of 0·90. Nearly all model fit measures reach the criteria of being an acceptable model fit except chi-squared statistics. Scores on Female Nurses' Sensitivity to Male Genitalia Related Care can be best predicted by that of brief Fear of Negative Evaluation Scale, Embarrassability Scale and Situational Susceptibility to Embarrassment Scale. The anxiety of projecting a positive image and the pursuit of sexual propriety may underpin female nurses' sensitivity to male genitalia-related care. This trait can be measured by the 13-item female nurses' sensitivity-male genitalia-related care scale with satisfactory psychometric properties including internal consistency, reliability, content validity and construct validity. Particular attention shall be paid to the negative effects of social rules or norms including sexual propriety rules over (female) nurses' perceptions, attitudes and behaviours. Strengthening nursing education in this regard is important to overcome negative effects on female
Tourangeau, Ann E; Patterson, Erin; Saari, Margaret; Thomson, Heather; Cranley, Lisa
Health care is shifting out of hospitals into community settings. In Ontario, Canada, home care organizations continue to experience challenges recruiting and retaining nurses. However, factors influencing home care nurse retention that can be modified remain largely unexplored. Several groups of factors have been identified as influencing home care nurse intent to remain employed including job characteristics, work structures, relationships and communication, work environment, responses to work, and conditions of employment. The aim of this study was to test and refine a model that identifies which factors are related to home care nurse intentions to remain employed for the next 5 years with their current home care employer organization. A cross-sectional survey design was implemented to test and refine a hypothesized model of home care nurse intent to remain employed. Logistic regression was used to determine which factors influence home care nurse intent to remain employed. Home care nurse intent to remain employed for the next 5 years was associated with increasing age, higher nurse-evaluated quality of care, having greater variety of patients, experiencing greater meaningfulness of work, having greater income stability, having greater continuity of client care, experiencing more positive relationships with supervisors, experiencing higher work-life balance, and being more satisfied with salary and benefits. Home care organizations can promote home care nurse intent to remain employed by (a) ensuring nurses have adequate training and resources to provide quality client care, (b) improving employment conditions to increase income stability and satisfaction with pay and benefits, (c) ensuring manageable workloads to facilitate improved work-life balance, and (d) ensuring leaders are accessible and competent.
Perry, Rachel; Murphy, Molly; Haider, Sadia; Harwood, Bryna
We sought to explore the experiences of women who disclosed that their pregnancies resulted from rape in the abortion care setting, as well as the experiences of professionals involved in care of women with rape-related pregnancy. In-depth interviews were conducted with 9 patients who had terminated rape-related pregnancies and 12 professionals working in abortion care or rape crisis advocacy (5 abortion providers, 4 rape crisis center advocates, 2 social workers, and 1 clinic administrator). Transcribed interviews were coded and analyzed for themes related to the experiences of disclosing rape and the consequences of disclosure in the abortion care setting. Patients and professionals involved in care of women with rape-related pregnancy described opportunities arising from disclosure, including interpersonal (explaining abortion decision making in the context of assault, belief, and caring by providers), as well as structural opportunities (funding assistance, legal options, and mental health options). Whereas most patients did not choose to pursue all three structural opportunities, both patients and professionals emphasized the importance of offering them. The most important consequence of disclosure for patients was being believed and feeling that providers cared about them. Rape-related pregnancy disclosure in the abortion care setting can lead to opportunities for interpersonal support and open options for funding, legal recourse, and mental health care. Those working in abortion care should create environments conducive to disclosure and opportunities for rape survivors to access these additional options if they desire. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Dunn, E V; Bass, M J; Williams, J I; Borgiel, A E; MacDonald, P; Spasoff, R A
A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.
van Lieshout, Jan; Frigola Capell, Eva; Ludt, Sabine; Grol, Richard; Wensing, Michel
Cardiovascular risk management (CVRM) received by patients shows large variation across countries. In this study we explored the aspects of primary care organisation associated with key components of CVRM in coronary heart disease (CHD) patients. Observational study. 273 primary care practices in Austria, Belgium, England, Finland, France, Germany, The Netherlands, Slovenia, Switzerland and Spain. A random sample of 4563 CHD patients identified by coded diagnoses in eight countries, based on prescription lists and while visiting the practice in one country each. We performed an audit in primary care practices in 10 European countries. We used six indicators to measure key components of CVRM: risk factor recording, antiplatelet therapy, influenza vaccination, blood pressure levels (systolic organisation based on 39 items. Using multilevel regression analyses we explored the effects of practice organisation on CVRM, controlling for patient characteristics. Better overall organisation of a primary care practice was associated with higher scores on three indicators: risk factor registration (B=0.0307, porganisation was not found to be related with recorded blood pressure or cholesterol levels. Only the organisational domains 'self-management support' and 'use of clinical information systems' were linked to three CVRM indicators. A better organisation of a primary care practice was associated with better scores on process indicators of CVRM in CHD patients, but not on intermediate patient outcome measures. Direct support for patients and clinicians seemed most influential.
Perry, Rachel; Murphy, Molly; Rankin, Kristin M; Cowett, Allison; Harwood, Bryna
We aimed to explore current practices regarding screening for rape and response to disclosure of rape-related pregnancy in the abortion care setting. We performed a cross-sectional, nonprobability survey of U.S. abortion providers. Individuals were recruited in person and via emailed invitations to professional organization member lists. Questions in this web-based survey pertained to providers' practice setting, how they identify rape-related pregnancy, the availability of support services, and their experiences with law enforcement. Providers were asked their perceptions of barriers to care for women who report rape-related pregnancy. Surveys were completed by 279 providers (21% response rate). Most respondents were female (93.1%), and the majority were physicians in a clinical role (69.4%). One-half (49.8%) reported their practice screens for pregnancy resulting from rape, although fewer (34.8%) reported that screening is the method through which most patients with this history are identified. Most (80.6%) refer women with rape-related pregnancy to support services such as rape crisis centers. Relatively few (19.7%) have a specific protocol for care of women who report rape-related pregnancy. Clinics that screen were 79% more likely to have a protocol for care than centers that do not screen. Although the majority (67.4%) reported barriers to identification of women with rape-related pregnancy, fewer (33.3%) reported barriers to connecting them to support services. Practices for identifying and providing care to women with rape-related pregnancy in the abortion care setting are variable. Further research should address barriers to care provision, as well as identifying protocols for care. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Kamath-Rayne, Beena D; Griffin, Jennifer B; Moran, Katelin; Jones, Bonnie; Downs, Allan; McClure, Elizabeth M; Goldenberg, Robert L; Rouse, Doris; Jobe, Alan H
To evaluate the impact of neonatal resuscitation and basic obstetric care on intrapartum-related neonatal mortality in low and middle-income countries, using the mathematical model, Maternal and Neonatal Directed Assessment of Technology (MANDATE). Using MANDATE, we evaluated the impact of interventions for intrapartum-related events causing birth asphyxia (basic neonatal resuscitation, advanced neonatal care, increasing facility birth, and emergency obstetric care) when implemented in home, clinic, and hospital settings of sub-Saharan African and India for 2008. Total intrapartum-related neonatal mortality (IRNM) was acute neonatal deaths from intrapartum-related events plus late neonatal deaths from ongoing intrapartum-related injury. Introducing basic neonatal resuscitation in all settings had a large impact on decreasing IRNM. Increasing facility births and scaling up emergency obstetric care in clinics and hospitals also had a large impact on decreasing IRNM. Increasing prevalence and utilization of advanced neonatal care in hospital settings had limited impact on IRNM. The greatest improvement in IRNM was seen with widespread advanced neonatal care and basic neonatal resuscitation, scaled-up emergency obstetric care in clinics and hospitals, and increased facility deliveries, resulting in an estimated decrease in IRNM to 2.0 per 1,000 live births in India and 2.5 per 1,000 live births in sub-Saharan Africa. With more deliveries occurring in clinics and hospitals, the scale-up of obstetric care can have a greater effect than if modeled individually. Use of MANDATE enables health leaders to direct resources towards interventions that could prevent intrapartum-related deaths. A lack of widespread implementation of basic neonatal resuscitation, increased facility births, and emergency obstetric care are missed opportunities to save newborn lives.
Providing adequate culture-sensitive care for a large number of refugees with trauma-related disorders constitutes a major challenge. In this context, peer support and trauma-informed peer counselling can be regarded as a valuable means to complement the psychosocial care systems. In recent years, peer support and peer education have been successfully implemented e. g. in health care education, in psychiatric care, and in the treatment of traumatized individuals. Only little research data is available for traumatized refugees. However, results are encouraging. A program is presented which integrates trauma-informed peer educators (TIP) with migration background in the care of traumatized refugees. Peers' responsibility includes emotional support and understanding the refugees' needs, sensitizing for trauma-related disorders, providing psychoeducation, and teaching trauma-specific stabilization techniques under supervision of professional psychotherapists. © Georg Thieme Verlag KG Stuttgart · New York.
Vásquez, Felipe; Paraje, Guillermo; Estay, Manuel
To measure and explain income-related inequalities in health and health care utilization in the period 2000 - 2009 in Chile, while assessing variations within the country and determinants of inequalities. Data from the National Socioeconomic Characterization Survey for 2000, 2003, and 2009 were used to measure inequality in health and health care utilization. Income-related inequality in health care utilization was assessed with standardized concentration indices for the probability and total number of visits to specialized care, generalized care, emergency care, dental care, mental health care, and hospital care. Self-assessed health status and physical limitations were used as proxies for health care need. Standardization was performed with demographic and need variables. The decomposition method was applied to estimate the contribution of each factor used to calculate the concentration index, including ethnicity, employment status, health insurance, and region of residence. In Chile, people in lower-income quintiles report worse health status and more physical limitations than people in higher quintiles. In terms of health service utilization, pro-rich inequities were found for specialized and dental visits with a slight pro-rich utilization for general practitioners and all physician visits. All pro-rich inequities have decreased over time. Emergency room visits and hospitalizations are concentrated among lower-income quintiles and have increased over time. Higher education and private health insurance contribute to a pro-rich inequity in dentist, general practitioner, specialized, and all physician visits. Income contributes to a pro-rich inequity in specialized and dentist visits, whereas urban residence and economic activity contribute to a pro-poor inequity in emergency room visits. The pattern of health care utilization in Chile is consistent with policies implemented in the country and in the intended direction. The significant income inequality in the
Full Text Available Background and Objectives: Diabetes is one of the most common health problems with remarkable outcomes. Treatment and management of diabetes is mainly related to self-care status. This study aimed to analyzing self-care behaviors and its related factors in diabetic patients. Methods: In this descriptive study, 131 diabetic patients referred to the Tuyserkan Diabetes Clinic in 2014, were studied by census method. Self-care behaviors data were collected by self-care scale of Toobert and Glasgow. Background information of diabetic patients, were investigated using pre-designed checklists based on forms in patients` records. Data were analyzed using Mann-Whitney, Kruskal-Wallis, and Spearman’s correlation coefficient tests. The significance level was considered to be 5%. Results: Out of total 131 diabetic patients, 66 persons (50.4% were male and 65 persons (49.6% were female. Their mean age was 51.8 years. Eight patients had heart disease complications. The mean self-care scores of the patients was 25.6 and was indicative of average level of self-care. Self-care behaviors were significantly associated with education level, employment status, type of treatment, and body mass index. There was a significant relationship between self-care components (including diet, physical activity, blood glucose testing and foot care. Conclusion: Considering the self-care status of patients and the importance of self-care training for diabetics, more attention should be paid to self-care in diabetic patients in health education and health promotion programs.
Byatt, Nancy; Xiao, Rui S; Dinh, Kate H; Waring, Molly E
We examined mental health care use in relation to depressive symptoms (Patient Health Questionnaire (PHQ-9) ≥ 10) among a nationally representative sample of pregnant women using data from the National Health and Nutrition Examination Survey 2005-2012. Logistic regression models estimated crude and adjusted odds ratios for mental health care use in the past year in relation to depressive symptoms. While 8.2 % (95 % CI 4.6-11.8) of pregnant women were depressed, only 12 % (95 % CI 1.8-22.1) of these women reported mental health care use in the past year.
Igarashi, Ayumi; Kurinobu, Takeshi; Ko, Ayako; Okamoto, Yuko; Matsuura, Shino; Feng, Mei; Yamamoto-Mitani, Noriko
To promote home death, it is necessary to clarify the institutional barriers to conducting end-of-life (EOL) care and consider strategies to deal with this process. This study aims to clarify institution-related factors associated with the provision of home-based EOL care cases, and to compare them among three different types of home-care agencies. We administered a cross-sectional survey throughout Japan to investigate the number and characteristics of EOL cases of home-care nursing (HN), home-help (HH) and care management (CM) agencies. Bivariate and multivariate analyses were performed for each type of agency to examine factors related to the provision of EOL care. 378 HN agencies, 274 HH agencies, and 452 CM agencies responded to the distributed questionnaire. HN agencies had on average 2.1 (SD = 4.0; range 0-60) home-based EOL cases in the last 3 months, while HH agencies had 0.9 (SD = 1.3; range 0-7) and CM agencies had 1.5 (SD = 2.2; range 0-18) in the last 6 months. In a multivariable analysis of HN agencies, a large number of staff (OR: 1.52; p EOL care; in HH agencies, accepting EOL clients in the agency (OR: 3.29; p EOL care; in CM agencies, the number of staff (OR: 1.21; p = 0.037), the number of collaborating HH agencies (OR: 1.07; p = 0.032), and whether home-care nurses and home helpers visit clients together (OR: 1.89; p = 0.007) were positively associated with the provision of EOL care. The agency's size and the inter-agency collaborative system seemed most important among HN agencies and CM agencies, while institutional preparedness for EOL was most important for HH agencies. These findings represent important new information for targeting different effective strategies in the promotion of home-based EOL care, depending on the agency type.
Shen, Sijun; Neyens, David M
There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers' age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers' age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs. Copyright © 2015 Elsevier Ltd. All rights reserved.
Mundt, Marlon P; Zakletskaia, Larissa I; Shoham, David A; Tuan, Wen-Jan; Carayon, Pascale
Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. Excessive alcohol-using patients may fair better if cared for by teams whose
Kuzishchin, V. F.; Merzlikina, E. I.; Van Va, Hoang
The problem of PID and PI-algorithms tuning by means of the approximation by the least square method of the frequency response of a linear algorithm to the sub-optimal algorithm is considered. The advantage of the method is that the parameter values are obtained through one cycle of calculation. Recommendations how to choose the parameters of the least square method taking into consideration the plant dynamics are given. The parameters mentioned are the time constant of the filter, the approximation frequency range and the correction coefficient for the time delay parameter. The problem is considered for integrating plants for some practical cases (the level control system in a boiler drum). The transfer function of the suboptimal algorithm is determined relating to the disturbance that acts in the point of the control impact input, it is typical for thermal plants. In the recommendations it is taken into consideration that the overregulation for the transient process when the setpoint is changed is also limited. In order to compare the results the systems under consideration are also calculated by the classical method with the limited frequency oscillation index. The results given in the paper can be used by specialists dealing with tuning systems with the integrating plants.
Goldsmith, Christopher; Cyboran, Steven F
Suboptimal employee decisions are prevalent in employee benefit plans. Poor decisions have significant consequences for employees and employers. Improving participant decisions produces beneficial outcomes such as lower labor costs, higher productivity and better workforce management. The business case for employee benefits can be strengthened by applying lessons learned from the field of behavioral economics to employee benefit plan design and to workforce communication. This article explains the types of behavioral biases that influence suboptimal decisions and explores how enlightened employee benefit plan choice architecture and vivid behavioral messaging contribute to human and better organizational outcomes.
Young, J Christopher; Caron, Joshua E; Baughman, Brandon C; Sawyer, R John
Developing embedded indicators of suboptimal effort on objective neurocognitive testing is essential for detecting increasingly sophisticated forms of symptom feigning. The current study explored whether Symbol Span, a novel Wechsler Memory Scale-fourth edition measure of supraspan visual attention, could be used to discriminate adequate effort from suboptimal effort. Archival data were collected from 136 veterans classified into Poor Effort (n = 42) and Good Effort (n = 94) groups based on symptom validity test (SVT) performance. The Poor Effort group had significantly lower raw scores (p Span test. A raw score cutoff of Span can effectively differentiate veterans with multiple failures on established free-standing and embedded SVTs.
J.M. Hartgerink (Jacqueline); J.M. Cramm (Jane); T.J.E.M. Bakker (Ton); A.M. van Eijsden (A.); J.P. Mackenbach (Johan); A.P. Nieboer (Anna)
textabstractAim: To identify predictors of relational coordination among professionals delivering care to older patients. Background: Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design: This cross-sectional
Farmer, Jane; Stimpson, Paul; Tucker, Janet
There is evidence of variation and some ambiguity about self-perceived relative professional roles in antenatal care in the UK. There is little information about models of antenatal care provision in UK rural areas. In rural areas, in particular, women have limited choice in accessing health care professionals or alternative primary care delivery settings. In the light of a recent review of Scottish maternity services, it is important and timely to examine models of care and interprofessional working in antenatal care in rural areas. This study explores midwives' and GPs' perceptions about their relative professional roles in remote and rural general practice in Scotland. A questionnaire survey involving all 174 Scottish remote and rural general practices (using one definition of rurality) was conducted, followed by 20 interviews. At least one professional returned a completed questionnaire from 91% of rural practices. A number of areas of dissonance were noted between GPs' and midwives' perceptions of their roles in maternity care and, given the context of service provision, these may impact upon rural patients. Findings are relevant to wider debates on extending the primary care team and strengthening inter-disciplinary working, particularly in rural areas.
Courvoisier, Delphine Sophie; Cullati, Stephane; Ouchi, Rieko; Schmidt, Ralph Eric; Haller, Guy; Chopard, Pierre; Agoritsas, Thomas; Perneger, Thomas V
Coping with difficult care-related situations is a common challenge for health-care professionals. How these professionals deal with the regrets they may experience following one of the many decisions and interventions they must make every day can have an impact on their own health and quality of life, and also on their patient care practices. To identify professionals most at need for extra support, development and validation of a tool measuring coping style are needed. We performed a survey of physicians and nurses of a French-speaking University hospital; 469 health-care professionals responded to the survey, and 175 responded to the same survey one-month later. Regret was assessed with the regret coping scale developed for this study, self-report questions on the frequency of regretted situations and the intensity of regret. Construct validity was assessed using measures of health-care professionals' quality of life (including job and life satisfaction, and self-reported health) as well as sleep problems and depression. Based on factor analysis and item response analysis, the initial 31-item scale was shortened to 15 items, which measured three types of strategies: problem-focused strategies (i.e., trying to find solutions, talking to colleagues) and two types of emotion-focused strategies, A (i.e., self-blame, rumination) and B (e.g., acceptance, emotional distance). All subscales showed high internal consistency (α >0.85). Overall, as expected, problem-focused and emotion-focused B strategies correlated with higher quality of life, fewer sleep problems and less depression, and emotion-focused A strategies showed the opposite pattern. The regret coping scale (RCS-HCP) is a valid and reliable measure of coping abilities of hospital-based health-care professionals.
Richardus, J.H.; Graafmans, W.C.; Bergsjø, P.; Lloyd, D.J.; Bakketeig, L.S.; Bannon, E.M.; Borkent-Polet, M.; Davidson, L.L.; Defoort, P.; Esparteiro Leitão, A.; Langhoff-Roos, J.; Moral Garcia, A.; Papantoniou, N.E.; Wennergren, M.; Amelink-Verburg, M.P.; Verloove-Vanhorick, S.P.; Mackenbach, J.P.
Background: A European concerted action (the EuroNatal study) investigated differences in perinatal mortality between countries of Europe. This report describes the methods used in the EuroNatal international audit and discusses the validity of the results. Methods: Perinatal deaths between 1993 and
Alli, Farzana; Maharaj, Pranitha; Vawda, Mohammed Yacoob
Interpersonal relations between health care providers and young clients have long being cited as an important element for improving client up take of services, satisfaction and overall health outcomes. In an era of HIV and AIDS this forms a critical determinant to young people accessing sexual and reproductive health care. This study explores to what extent interpersonal relations form a barrier to young peoples access to and satisfaction of health services. The study draws on data from 200 client exit interviews and four in-depth interviews conducted with university students and university health care staff in Kwazulu-Natal, South Africa. While young people are aware of the importance of utilising STI, HIV and family planning services they experienced barriers in their relationship with providers. This served as a deterrent to their use of the health facility. Adequate training in interpersonal relations for youth-friendly service provision is essential in helping overcome communication problems and enabling providers to interact with young clients at a more personal level.
Morgan, Debra G; Kosteniuk, Julie G; Stewart, Norma J; O'Connell, Megan E; Kirk, Andrew; Crossley, Margaret; Dal Bello-Haas, Vanina; Forbes, Dorothy; Innes, Anthea
Community-based services are important for improving outcomes for individuals with dementia and their caregivers. This study examined: (a) availability of rural dementia-related services in the Canadian province of Saskatchewan, and (b) orientation of services toward six key attributes of primary health care (i.e., information/education, accessibility, population orientation, coordinated care, comprehensiveness, quality of care). Data were collected from 71 rural Home Care Assessors via cross-sectional survey. Basic health services were available in most communities (e.g., pharmacists, family physicians, palliative care, adult day programs, home care, long-term care facilities). Dementia-specific services typically were unavailable (e.g., health promotion, counseling, caregiver support groups, transportation, week-end/night respite). Mean scores on the primary health care orientation scales were low (range 12.4 to 17.5/25). Specific services to address needs of rural individuals with dementia and their caregivers are limited in availability and fit with primary health care attributes.
Full Text Available This paper discusses mathematical and statistical aspects in analysis methods applied to microarray gene expressions. We focus on pattern recognition to extract informative features embedded in the data for prediction of phenotypes. It has been pointed out that there are severely difficult problems due to the unbalance in the number of observed genes compared with the number of observed subjects. We make a reanalysis of microarray gene expression published data to detect many other gene sets with almost the same performance. We conclude in the current stage that it is not possible to extract only informative genes with high performance in the all observed genes. We investigate the reason why this difficulty still exists even though there are actively proposed analysis methods and learning algorithms in statistical machine learning approaches. We focus on the mutual coherence or the absolute value of the Pearson correlations between two genes and describe the distributions of the correlation for the selected set of genes and the total set. We show that the problem of finding informative genes in high dimensional data is ill-posed and that the difficulty is closely related with the mutual coherence.
Davies, Sue; Nolan, Mike
Despite a growing awareness of the significance of helping a relative to relocate to a care home as a key phase in the caregiving career, relatively few studies in the UK have explored this experience in depth. The research on which the present paper is based sought to better understand experiences of nursing home placement from the viewpoint of relatives. The study was informed by a constructivist perspective. Data were collected in 37 semi-structured interviews involving 48 people who had assisted a close relative to move into a nursing home. Data analysis revealed three phases of the transition from the relatives' perspective: 'making the best of it'; 'making the move'; and 'making it better'. The relatives' experiences across these phases were understood in terms of five continua, reflecting the extent to which they felt they were: operating 'under pressure' or not; 'working together' or 'working alone'; 'supported' or 'unsupported', both practically and emotionally; 'in the know' or 'working in the dark'; and 'in control of events' or not. This paper reports on the findings which relate to the second phase of the transition, 'making the move', which relates to experiences around the time of relocation to the care home environment. The findings suggest that health and social care practitioners have enormous potential to influence relatives' experiences of nursing home entry. Experiences are enhanced if family carers perceive that they are able to work in partnership with care staff in order to ease the transition for the older person.
Hewitt, Caroline; Cappiello, Joyce
To identify the essential competencies for prevention and care related to unintended pregnancy to develop program outcomes for nursing curricula. Modified Delphi study. National. Eighty-five nurse experts, including academic faculty and advanced practice nurses providing sexual and reproductive health care in primary or specialty care settings. Expert panelists completed a three-round Delphi study using an electronic survey. Eighty-five panelists completed the first round survey, and 72 panelists completed all three rounds. Twenty-seven items achieved consensus of at least 75% of the experts by the third round to comprise the educational competencies. Through an iterative process, experts in prevention and care related to unintended pregnancy reached consensus on 27 core educational competencies for nursing education. The competencies provide a framework for curricular development in an important area of nursing education. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
Pourhabib, Sanam; Chessex, Caroline; Murray, Judy; Grace, Sherry L
Cardiovascular rehabilitation has been designed to decrease the burden of cardiovascular disease. This study described (1) patient-health-care provider interactions regarding cardiovascular rehabilitation and (2) which discussion elements were related to patient referral. This was a prospective study of cardiovascular patients and their health-care providers. Discussion utterances were coded using the Roter Interaction Analysis System. Discussion between 26 health-care providers and 50 patients were recorded. Cardiovascular rehabilitation referral was related to greater health-care provider interactivity (odds ratio = 2.82, 95% confidence interval = 1.01-7.86) and less patient concern and worry (odds ratio = 0.64, 95% confidence interval = 0.45-0.89). Taking time for reciprocal discussion and allaying patient anxiety may promote greater referral. © The Author(s) 2014.
Heidenreich, Kaja; Bremer, Anders; Materstvedt, Lars Johan; Tidefelt, Ulf; Svantesson, Mia
In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals' moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient's nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient's autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients' influence and at the same time take responsibility for their needs as vulnerable humans.
Barth, Angélica Adam; Weigel, Bruna Dorfey; Dummer, Claus Dieter; Machado, Kelly Campara; Tisott, Taís Montagner
To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors.
Lan, Chiao-Wen; Lin, Chunqing; Thanh, Duong Cong; Li, Li
There are considerable challenges faced by people with a history of injecting drug use (PWID) in Vietnam, including drug-related stigma and lack of access to healthcare. Seeking and utilising healthcare, as well as harm reduction programs for PWID, are often hampered by drug-related stigma. This study aimed to examine the impacts of drug-related stigma on access to care and utilisation of harm reduction programs among PWID in Vietnam. A cross-sectional study was conducted in two provinces in Vietnam, Phú Thọ and Vinh Phúc. The study participants completed the survey by using Audio Computer-Assisted Self-Interview between late 2014 and early 2015. Linear multiple regression models and logistic regression models were used to assess the relationship among drug-related stigma, access to care and utilisation of harm reduction programs, including methadone maintenance treatment (MMT) and needle exchange programs (NEP). A total of 900 PWID participated in this study. Drug-related stigma was significantly associated with lower level of access to care, but not with utilisation of MMT or NEP. Older age was positively associated with higher levels of access to care. Levels of education were positively correlated with access to care, as well as utilisation of MMT and NEP. This study underscores the need for future interventions to reduce drug-related stigma in society and in health-care settings to improve PWID's utilisation of care services. Special attention should be paid to younger PWID and those with lower levels of education. © 2017 Australasian Professional Society on Alcohol and other Drugs.
Alamgir, Hasanat; Cvitkovich, Yuri; Yu, Shicheng; Yassi, Annalee
To examine how injury rates and injury types differ across direct care occupations in relation to the healthcare settings in British Columbia, Canada. Data were derived from a standardised operational database in three BC health regions. Injury rates were defined as the number of injuries per 100 full-time equivalent (FTE) positions. Poisson regression, with Generalised Estimating Equations, was used to determine injury risks associated with direct care occupations (registered nurses [RNs], licensed practical nurses [LPNs) and care aides [CAs]) by healthcare setting (acute care, nursing homes and community care). CAs had higher injury rates in every setting, with the highest rate in nursing homes (37.0 injuries per 100 FTE). LPNs had higher injury rates (30.0) within acute care than within nursing homes. Few LPNs worked in community care. For RNs, the highest injury rates (21.9) occurred in acute care, but their highest (13.0) musculoskeletal injury (MSI) rate occurred in nursing homes. MSIs comprised the largest proportion of total injuries in all occupations. In both acute care and nursing homes, CAs had twice the MSI risk of RNs. Across all settings, puncture injuries were more predominant for RNs (21.3% of their total injuries) compared with LPNs (14.4%) and CAs (3.7%). Skin, eye and respiratory irritation injuries comprised a larger proportion of total injuries for RNs (11.1%) than for LPNs (7.2%) and CAs (5.1%). Direct care occupations have different risks of occupational injuries based on the particular tasks and roles they fulfil within each healthcare setting. CAs are the most vulnerable for sustaining MSIs since their job mostly entails transferring and repositioning tasks during patient/resident/client care. Strategies should focus on prevention of MSIs for all occupations as well as target puncture and irritation injuries for RNs and LPNs.
Nishide, Akemi; Fujita, Misuzu; Sato, Yasunori; Nagashima, Kengo; Takahashi, Sho; Hata, Akira
Background : This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods : The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results : Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions : There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system.
Full Text Available Introduction: Clinical competence of nurses working in the neonatal intensive care units together with advancements in medical science and technology increased the survival rate of newborns that need specialized care. To ensure the quality of care and provide the safety of patients, evaluating the clinical competence of nurses seems necessary. This study aimed to evaluate the clinical competence of nurses in the neonatal intensive care units. Methods: In this cross-sectional study, 117 nurses working in the neonatal intensive care units of the hospitals affiliated to Tehran University of Medical Sciences were selected by census method. The research tool was Development of Competency Inventory for Registered Nurses questionnaire which completed by self-assessment. The mean clinical competence scores of participants categorized into 3 levels: weak: 273. Data were analyzed by SPSS version 13 using the Pearson correlation coefficient, t-test and Chi-square test. Results: The highest levels of competence were related to critical thinking and research attitude and interpersonal relationships, and the lowest level was related to training and mentoring. There was a direct statistically significant relationship between marital status, employment status, level of interest in working in the neonatal intensive-care units and the clinical competence of nurses. Conclusion: Since the clinical competence of nurses in the Neonatal Intensive Care Units is vital, some variables such as interest in the nursing profession, employment status, the neonatal intensive theoretical and practical training courses and the amount of overtime working hours should be taken into consideration.
Consumers have been found to majorly prefer ‘optimal’ food over ‘suboptimal’ when purchasing food. To provide an incentive for consumers to select suboptimal food and thus decrease food waste in the supply chain, expiration date based pricing is suggested and increasingly applied. However......, it is unclear which contextual, individual, and product-related factors impact consumer likelihood of choice and thus acceptance of the practice in the long run. The study aimed at exploring the effect of communicating different motives for purchase, the product being organic, familiarity with the practice......, individual preferences, and product-related factors. An online survey experiment among 842 Danish consumers realistically mimicked the current market context. Findings reveal that neither communicating budget saving or food waste avoidance nor the product being organic has an influence. However...
Full Text Available Abstract Background Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. Methods A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. Results Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. Conclusion Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to
Mamhidir, Anna-Greta; Kihlgren, Mona; Sorlie, Venke
Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to stimulate discussions between high level decision-makers and health
Bouman, Zita; Hendriks, Marc P H; Schmand, Ben A; Kessels, Roy P C; Aldenkamp, Albert P
Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the identification of suboptimal performance using an analogue study design. The patient group consisted of 59 mixed-etiology patients; the experimental malingerers were 50 healthy individuals who were asked to simulate cognitive impairment as a result of a traumatic brain injury; the last group consisted of 50 healthy controls who were instructed to put forth full effort. Experimental malingerers performed significantly lower on all WMS-IV-NL tasks than did the patients and healthy controls. A binary logistic regression analysis was performed on the experimental malingerers and the patients. The first model contained the visual working memory subtests (Spatial Addition and Symbol Span) and the recognition tasks of the following subtests: Logical Memory, Verbal Paired Associates, Designs, Visual Reproduction. The results showed an overall classification rate of 78.4%, and only Spatial Addition explained a significant amount of variation (p < .001). Subsequent logistic regression analysis and receiver operating characteristic (ROC) analysis supported the discriminatory power of the subtest Spatial Addition. A scaled score cutoff of <4 produced 93% specificity and 52% sensitivity for detection of suboptimal performance. The WMS-IV-NL Spatial Addition subtest may provide clinically useful information for the detection of suboptimal performance.
Bouman, Z.; Hendriks, M.P.H.; Schmand, B.A.; Kessels, R.P.C.; Aldenkamp, A.P.
INTRODUCTION: Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the
Bouman, Zita; Hendriks, Marc P. H.; Schmand, Ben A.; Kessels, Roy P. C.; Aldenkamp, Albert P.
Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the identification of
Bouman, Z.; Hendriks, M.P.H.; Schmand, B.A.; Kessels, R.P.C.; Aldenkamp, A.P.
INTRODUCTION: Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the
Bouman, Zita; Hendriks, Marc P.H.; Schmand, Ben A.; Kessels, Roy P.C.; Aldenkamp, Albert P.
Introduction. Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the
Noome, M.; Beneken genaamd Kolmer, D.M.; Leeuwen, E. van; Dijkstra, B.M.; Vloet, L.C.M.
AIM: The aim of this study was to explore how intensive care unit (ICU) nurses describe their role during End-of-Life Care (EOLC) in the ICU, related to the interaction between patient, family and professionals (care triad). METHOD: Three electronic databases, PubMed, CINAHL and EMBASE, and
Noome, M.; Beneken genaamd Kolmer, D.M.; van Leeuwen, E.; Dijkstra, B.M.; Vloet, L.
Aim The aim of this study was to explore how intensive care unit (ICU) nurses describe their role during End-of-Life Care (EOLC) in the ICU, related to the interaction between patient, family and professionals (care triad). Method Three electronic databases, PubMed, CINAHL and EMBASE, and reference
Larkin, Philip J; Dierckx de Casterlé, Bernadette; Schotsmans, Paul
This paper is a report of a concept evaluation of transience and its relevance to palliative care. A qualitative study into palliative care patients' experiences of transition revealed a gap between current definitions of transition and their expression of the palliative care experience. Transience appears to offer a better definition but remains conceptually weak, with limited definition in a healthcare context. A qualitative conceptual evaluation of transience was undertaken using two case examples, interview data and the literature. Multiple sources were used to identify the literature (1966-2006), including a search on Cumulative Index to Nursing and Allied Health Literature Medline, and Ovid and Arts and Humanities Index using the keywords 'transience' and 'palliative care'. Thirty-one papers related to transience were retrieved. Analysis and synthesis formulated a theoretical definition of transience relative to palliative care. Transience is a nascent concept. Preconditions and outcomes of transience appear contextually dependent, which may inhibit its conceptual development. Transience depicts a fragile emotional state related to sudden change and uncertainty at end-of-life, exhibited as a feeling of stasis. Defining attributes would seem to include fragility, suddenness, powerlessness, impermanence, time, space, uncertainty, separation and homelessness. Transience is potentially more meaningful for palliative care in understanding the impact of end-of-life experiences for patients than current conceptualizations of transition as a process towards resolution. As a nascent concept, it remains strongly encapsulated within a framework of transition and further conceptual development is needed to enhance its maturity and refinement.
Noël, Polly Hitchcock; Wang, Chen-Pin; Finley, Erin P; Espinoza, Sara E; Parchman, Michael L; Bollinger, Mary J; Hazuda, Helen P
The Institute of Medicine (IOM) suggests that linkages between primary care practices and community-based resources can improve health in lower income and minority patients, but examples of these are rare. We conducted a prospective, mixed-methods observational study to identify indicators of primary care-community linkage associated with the frequency of visits to community-based senior centers and improvements in diabetes-related outcomes among 149 new senior center members (72% Hispanic). We used semistructured interviews at baseline and 9-month follow-up, obtaining visit frequency from member software and clinical assessments including hemoglobin A1c (HbA1c) from colocated primary care clinics. Members' discussion of their activities with their primary care providers (PCPs) was associated with increased visits to the senior centers, as well as diabetes-related improvements. Direct feedback from the senior centers to their PCPs was desired by the majority of members and may help to reinforce use of community resources for self-management support.
Hatzmann, J.; Heymans, H.S.A.; Ferrer-i-Carbonell, A.; van Praag, B.M.S.; Grootenhuis, M.A.
CONTEXT. The number of parents who care for a chronically ill child is increasing. Because of advances in medical care, parental caring tasks are changing. A detailed description of parental health-related quality of life will add to the understanding of the impact of caring for a chronically ill
Hatzmann, Janneke; Heymans, Hugo S. A.; Ferrer-I-Carbonell, Ada; van Praag, Bernard M. S.; Grootenhuis, Martha A.
CONTEXT. The number of parents who care for a chronically ill child is increasing. Because of advances in medical care, parental caring tasks are changing. A detailed description of parental health-related quality of life will add to the understanding of the impact of caring for a chronically ill
Conceição Aparecida de Mattos Segre
Full Text Available Objective: To compare sub-optimal birth weight (2,500 to 2,999 g term newborns to appropriate for gestational age (birth weight ≥ 3,000 g term newborns, regarding maternal data and newborn morbidity and mortality. Methods: Single term newborns, appropriate for gestational age from a high socioeconomic population (n = 1,242 with birth weight ranging from 2,500 to 2,999 g (Group I were compared to 4,907 newborns with birth weight ≥ than 3,000 g (Group II. Maternal and newborn characteristics were compared between the groups. The Mann-Whitney test, χ2 test and multivariate analysis were used. The significance level adopted was p < 0.05. Rresults: The frequency of sub-optimal birth weight newborns in the population studied was 20.2%. There was a significant association between sub-optimal birth weight and maternal weight before pregnancy and body mass index, maternal weight gain, height, smoking habit and hypertension. Newborns’ 1-minute Apgar score, neonatal hypoglycemia, jaundice, transient tachypnea, congenital pneumonia and hospital stay were significantly different between the groups (p < 0.05. A significant relationship could not be established with the 5-minute Apgar score and pulmonary hypertension in both groups. Neonatal mortality did not differ between the groups. Cconclusions: Socioeconomic status was not a risk factor for sub-optimal birth weight in the studied population. Genetic and environmental factors were associated to sub-optimal weight and neonatal diseases. According to these data, this group of newborns should receive special attention from the health team.
Gerestein, Cornelis G; Eijkemans, Marinus J; Bakker, Jeanette; Elgersma, Otto E; van der Burg, Maria E L; Kooi, Geertruida S; Burger, Curt W
Maximal cytoreduction to minimal residual tumor is the most important determinant of prognosis in patients with advanced stage epithelial ovarian cancer (EOC). Preoperative prediction of suboptimal cytoreduction, defined as residual tumor >1 cm, could guide treatment decisions and improve counseling. The objective of this study was to identify predictive computed tomographic (CT) scan and clinical parameters for suboptimal cytoreduction at primary cytoreductive surgery for advanced stage EOC and to generate a nomogram with the identified parameters, which would be easy to use in daily clinical practice. Between October 2005 and December 2008, all patients with primary surgery for suspected advanced stage EOC at six participating teaching hospitals in the South Western part of the Netherlands entered the study protocol. To investigate independent predictors of suboptimal cytoreduction, a Cox proportional hazard model with backward stepwise elimination was utilized. One hundred and fifteen patients with FIGO stage III/IV EOC entered the study protocol. Optimal cytoreduction was achieved in 52 (45%) patients. A suboptimal cytoreduction was predicted by preoperative blood platelet count (p=0.1990; odds ratio (OR)=1.002), diffuse peritoneal thickening (DPT) (p=0.0074; OR=3.021), and presence of ascites on at least two thirds of CT scan slices (p=0.0385; OR=2.294) with a for-optimism corrected c-statistic of 0.67. Suboptimal cytoreduction was predicted by preoperative platelet count, DPT and presence of ascites. The generated nomogram can, after external validation, be used to estimate surgical outcome and to identify those patients, who might benefit from alternative treatment approaches.
Kristjansson, Elizabeth; Hogg, William; Dahrouge, Simone; Tuna, Meltem; Mayo-Bruinsma, Liesha; Gebremichael, Goshu
Continuity is a fundamental tenet of primary care, and highly valued by patients; it may also improve patient outcomes and lower cost of health care. It is thus important to investigate factors that predict higher continuity. However, to date, little is known about the factors that contribute to continuity. The purpose of this study was to analyse practice, provider and patient predictors of continuity of care in a large sample of primary care practices in Ontario, Canada. Another goal was to assess whether there was a difference in the continuity of care provided by different models of primary care. This study is part of the larger a cross-sectional study of 137 primary care practices, their providers and patients. Several performance measures were evaluated; this paper focuses on relational continuity. Four items from the Primary Care Assessment Tool were used to assess relational continuity from the patient's perspective. Multilevel modeling revealed several patient factors that predicted continuity. Older patients and those with chronic disease reported higher continuity, while those who lived in rural areas, had higher education, poorer mental health status, no regular provider, and who were employed reported lower continuity. Providers with more years since graduation had higher patient-reported continuity. Several practice factors predicted lower continuity: number of MDs, nurses, opening on weekends, and having 24 hours a week or less on-call. Analyses that compared continuity across models showed that, in general, Health Service Organizations had better continuity than other models, even when adjusting for patient demographics. Some patients with greater health needs experience greater continuity of care. However, the lower continuity reported by those with mental health issues and those who live in rural areas is concerning. Furthermore, our finding that smaller practices have higher continuity suggests that physicians and policy makers need to consider
Reed, Rachel; Sharman, Rachael; Inglis, Christian
Many women experience psychological trauma during birth. A traumatic birth can impact on postnatal mental health and family relationships. It is important to understand how interpersonal factors influence women's experience of trauma in order to inform the development of care that promotes optimal psychosocial outcomes. As part of a large mixed methods study, 748 women completed an online survey and answered the question 'describe the birth trauma experience, and what you found traumatising'. Data relating to care provider actions and interactions were analysed using a six-phase inductive thematic analysis process. Four themes were identified in the data: 'prioritising the care provider's agenda'; 'disregarding embodied knowledge'; 'lies and threats'; and 'violation'. Women felt that care providers prioritised their own agendas over the needs of the woman. This could result in unnecessary intervention as care providers attempted to alter the birth process to meet their own preferences. In some cases, women became learning resources for hospital staff to observe or practice on. Women's own embodied knowledge about labour progress and fetal wellbeing was disregarded in favour of care provider's clinical assessments. Care providers used lies and threats to coerce women into complying with procedures. In particular, these lies and threats related to the wellbeing of the baby. Women also described actions that were abusive and violent. For some women these actions triggered memories of sexual assault. Care provider actions and interactions can influence women's experience of trauma during birth. It is necessary to address interpersonal birth trauma on both a macro and micro level. Maternity service development and provision needs to be underpinned by a paradigm and framework that prioritises both the physical and emotional needs of women. Care providers require training and support to minimise interpersonal birth trauma.
Fragoso, Zachary L; Holcombe, Kyla J; McCluney, Courtney L; Fisher, Gwenith G; McGonagle, Alyssa K; Friebe, Susan J
This study's purpose was twofold: first, to examine the relative importance of job demands and resources as predictors of burnout and engagement, and second, the relative importance of engagement and burnout related to health, depressive symptoms, work ability, organizational commitment, and turnover intentions in two samples of health care workers. Nurse leaders (n = 162) and licensed emergency medical technicians (EMTs; n = 102) completed surveys. In both samples, job demands predicted burnout more strongly than job resources, and job resources predicted engagement more strongly than job demands. Engagement held more weight than burnout for predicting commitment, and burnout held more weight for predicting health outcomes, depressive symptoms, and work ability. Results have implications for the design, evaluation, and effectiveness of workplace interventions to reduce burnout and improve engagement among health care workers. Actionable recommendations for increasing engagement and decreasing burnout in health care organizations are provided. © 2016 The Author(s).
The US older population is growing in ethnic diversity. Persistent ethnic disparities in service use among seniors are linked to structural barriers to access, and also to family processes such as cultural preferences and intergenerational relations. There is sparse information on the latter issue for immigrant ethnic minority seniors. Information on the Asian group (the fastest growing senior sub-population) is extremely scarce, due to this group's diversity in national, linguistic, and cultural origins. We conducted a qualitative study among community-dwelling Asian Indian families (including at least one member aged 60 years and older) in North Carolina to examine preferences of seniors and the midlife generation regarding elder care, and the role of intergenerational relations in desired care for elders, exploring the theoretical perspective of intergenerational relationship ambivalence. Our results suggest that cultural preferences, ambivalence in intergenerational relations, and regulations on health service eligibility among immigrant/transnational seniors and midlife adults influence preferences for elder care.
Latocca, R; Riva, M A; D'Orso, M; Ploia, P; Rocca, S; De Vito, G; Cesana, G
The workload, the quality of professional relationships and emotional involvement have a significant impact on distress and burnout in health care-workers; this impact has an hight variability among the different environments and different care facilities (hospital, erderly nursing homes, home care). The risk assessment of work-related stress performed in 2010 in a homecare agency highlighted organizational problems related to the content/context of work and risk factors for health and safety. High turn-over is evidenced as critical among the "sentinel events". The level of job-strain was moderate, even if some critical issues were evidenced especially in the group of physiotherapists; nurses were configured as a homogeneous group with a low level of job-strain. In informative meetings the workers identified the discomfort related to the time for transferring patients from their homes in a high-traffic metropolitan area was identified as the most critical aspect.
Degli Esposti L
per person associated with the groups with good control, fair control, poor control, and very poor control was €219.28, €264.65, €513.18, and €564.79, respectively.Conclusion: Many patients showed suboptimal glycemic control. Lower levels of glycated hemoglobin were associated with lower diabetes-related health care costs. Integration of administrative databases and a laboratory database appears to be suitable for showing that appropriate management of diabetes can help to achieve better resource allocation.Keywords: diabetes mellitus, glycemic control, HbA1c, health expenditure
Degli Esposti, Luca; Saragoni, Stefania; Buda, Stefano; Sturani, Alessandra; Degli Esposti, Ezio
Diabetes is one of the most prevalent chronic diseases, and its prevalence is predicted to increase in the next two decades. Diabetes imposes a staggering financial burden on the health care system, so information about the costs and experiences of collecting and reporting quality measures of data is vital for practices deciding whether to adopt quality improvements or monitor existing initiatives. The aim of this study was to quantify the association between health care costs and level of glycemic control in patients with type 2 diabetes using clinical and administrative databases. A retrospective analysis using a large administrative database and a clinical registry containing laboratory results was performed. Patients were subdivided according to their glycated hemoglobin level. Multivariate analyses were used to control for differences in potential confounding factors, including age, gender, Charlson comorbidity index, presence of dyslipidemia, hypertension, or cardiovascular disease, and degree of adherence with antidiabetic drugs among the study groups. Of the total population of 700,000 subjects, 31,022 were identified as being diabetic (4.4% of the entire population). Of these, 21,586 met the study inclusion criteria. In total, 31.5% of patients had very poor glycemic control and 25.7% had excellent control. Over 2 years, the mean diabetes-related cost per person was: €1291.56 in patients with excellent control; €1545.99 in those with good control; €1584.07 in those with fair control; €1839.42 in those with poor control; and €1894.80 in those with very poor control. After adjustment, compared with the group having excellent control, the estimated excess cost per person associated with the groups with good control, fair control, poor control, and very poor control was €219.28, €264.65, €513.18, and €564.79, respectively. Many patients showed suboptimal glycemic control. Lower levels of glycated hemoglobin were associated with lower diabetes-related
Hou, Pik Yi; Lai, Claudia Kam Yuk; Chung, Ching Sum; Sham, Amy Kin Kwan; Yeung, Ching Lai
The aim of the present study was to explore the experiences and perceptions young adults had of family members who are caring for a relative with dementia. An exploratory qualitative study with semi-structured interviews was carried out and data were collected from 24 young adults recruited through purposive sampling. The participants had to have a close relative who was caring for an elderly family member with dementia. A content analysis approach was used for the verbatim transcription. The findings showed that caring for a relative with dementia was perceived as a time-consuming, exhausting and long-term task. The participants experienced stress and strain, although they were not the primary caregivers. Despite their negative perceptions of the task, they were willing to take on the responsibility of becoming a primary caregiver in the future. However, they intended to seek assistance in meeting their caregiving roles and responsibilities. Seeing how their close relative cared for a dependent older adult led them to reflect on what they would become in the future. Interestingly, although the participants expected their future offspring to take care of them when they became old, they did not want to be a burden to their children. Young adults are the caregivers of tomorrow. Knowing their perspective on caregiving is important if health professionals are to help them evolve into a caregiving role. It has implications for realizing the goal of aging in place. Geriatr Gerontol Int 2016; 16: 873-879. © 2015 Japan Geriatrics Society.
Lee, Eugenia E; Stewart, Barclay; Zha, Yuanting A; Groen, Thomas A; Burkle, Frederick M; Kushner, Adam L
Climate extremes will increase the frequency and severity of natural disasters worldwide. Climate-related natural disasters were anticipated to affect 375 million people in 2015, more than 50% greater than the yearly average in the previous decade. To inform surgical assistance preparedness, we estimated the number of surgical procedures needed. The numbers of people affected by climate-related disasters from 2004 to 2014 were obtained from the Centre for Research of the Epidemiology of Disasters database. Using 5,000 procedures per 100,000 persons as the minimum, baseline estimates were calculated. A linear regression of the number of surgical procedures performed annually and the estimated number of surgical procedures required for climate-related natural disasters was performed. Approximately 140 million people were affected by climate-related natural disasters annually requiring 7.0 million surgical procedures. The greatest need for surgical care was in the People's Republic of China, India, and the Philippines. Linear regression demonstrated a poor relationship between national surgical capacity and estimated need for surgical care resulting from natural disaster, but countries with the least surgical capacity will have the greatest need for surgical care for persons affected by climate-related natural disasters. As climate extremes increase the frequency and severity of natural disasters, millions will need surgical care beyond baseline needs. Countries with insufficient surgical capacity will have the most need for surgical care for persons affected by climate-related natural disasters. Estimates of surgical are particularly important for countries least equipped to meet surgical care demands given critical human and physical resource deficiencies.
Douma, Johanna G; Volkers, Karin M; Engels, Gwenda; Sonneveld, Marieke H; Goossens, Richard H M; Scherder, Erik J A
Despite the detrimental effects of physical inactivity for older adults, especially aged residents of residential care settings may spend much time in inactive behavior. This may be partly due to their poorer physical condition; however, there may also be other, setting-related factors that influence the amount of inactivity. The aim of this review was to review setting-related factors (including the social and physical environment) that may contribute to the amount of older adults' physical inactivity in a wide range of residential care settings (e.g., nursing homes, assisted care facilities). Five databases were systematically searched for eligible studies, using the key words 'inactivity', 'care facilities', and 'older adults', including their synonyms and MeSH terms. Additional studies were selected from references used in articles included from the search. Based on specific eligibility criteria, a total of 12 studies were included. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Based on studies using different methodologies (e.g., interviews and observations), and of different quality (assessed quality range: 25-100%), we report several aspects related to the physical environment and caregivers. Factors of the physical environment that may be related to physical inactivity included, among others, the environment's compatibility with the abilities of a resident, the presence of equipment, the accessibility, security, comfort, and aesthetics of the environment/corridors, and possibly the presence of some specific areas. Caregiver-related factors included staffing levels, the available time, and the amount and type of care being provided. Inactivity levels in residential care settings may be reduced by improving several features of the physical environment and with the help of caregivers. Intervention studies could be performed in order to gain more insight into causal effects of improving setting-related factors on
Tekindal, Benian; Tekindal, Mustafa Agah; Pinar, Gul; Ozturk, Filiz; Alan, Sumeyra
One of the biggest problems of work life today is burnout. With burnout, satisfaction of clients and service givers reduces. In this study, burnout levels of nurses working in the internal, surgical and intensive care units of a university hospital and the unmet needs of the patients' relatives related to nursing care were investigated. In the study, 225 nurses and 222 relatives of patients constituted the sample group of this study. Three separate forms were used in the study, namely, Nurse and Patient Relative Identification Form, the Maslach Burnout Inventory and the Nursing Services Satisfaction Inventory. In the study, burnout levels of the nurses were found to be high. Conditions like younger ages, scarcity of experience in the profession, lower levels of education, having chosen the profession and the unit they work in not willingly and working in environments like intensive care increase the burnout and as a result, expectations of the relatives of patients from nursing care are not fully met. Some suggestions have been made to make some regulations to prevent the burnout of nurses and to increase the satisfaction of relatives. © 2012 Blackwell Publishing Asia Pty Ltd.
Full Text Available Objectives: Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated. Methods: Suicides motivated by non-illness-related factors were identified using the investigator’s note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status. Results: Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women. Conclusions: Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.
Coogle, Constance L; Parham, Iris A; Jablonski, Rita; Rachel, Jason A
Changes in job satisfaction and career commitment were observed as a consequence of a geriatric case management training program focusing on skills development among personal care attendants in home care. A comparison of pretraining and posttraining scores uncovered a statistically significant increase in Intrinsic Job Satisfaction scores for participants 18-39 years of age, whereas levels declined among the group of middle aged participants and no change was observed among participants age 52 and older. On the other hand, a statistically significant decline in Extrinsic Job Satisfaction was documented over all participants, but this was found to be primarily due to declines among participants 40-51 years of age. When contacted 6-12 months after the training series had concluded participants indicated that the training substantially increased the likelihood that they would stay in their current jobs and improved their job satisfaction to some extent. A comparison of pretraining and posttraining scores among participants providing follow-up data revealed a statistically significant improvement in levels of Career Resilience. These results are discussed as they relate to similar training models and national data sets, and recommendations are offered for targeting future educational programs designed to address the long-term care workforce shortage.
Jenny Marlindawani Purba
Full Text Available Background: A caregiver is a primary nurse and has a major role in providing care for people with schizophrenia. Caring for those with schizophrenia for a long period of time is a challenge for families, especially caregivers. Various needs ought to be studied by nurses to assist caregivers in providing optimal care for family members who experience schizophrenia. Objective: This qualitative study aims to explore the needs of caregivers in treating schizophrenia at home. Methods: The method used in this study is the method of purposive sampling with the number of participants as many as 10 people with criteria: 1 have family members diagnosed with schizophrenia, 2 directly involved in home care patients, 3 caring for schizophrenia for more than one year, 4 willing to be a participant by signing informed consent, 4 being able to identify what is needed in treating schizophrenia. Colaizzi is used to analyze interview data. Results: The results of the study found four themes of caregiver needs in caring for schizophrenia patients at home, namely: 1 seeking information about schizophrenia, 2 sought schizophrenic relatives’ recovery, 3 looking for appropriate rehabilitation for relatives with schizophrenias, and 4 utilizing mental health facilities. Conclusions: It is expected that nurses have the knowledge and skills in identifying and helping families, especially caregivers, to meet unmet needs so they can optimize home care.
Tourigny, Jocelyne; Chartrand, Julie; Massicotte, Julie
Changes in health care delivery in Canada and Europe, especially the shift to ambulatory care, have modified the care that children and parents receive and have prompted the need for a partnership alliance. The objectives of this exploratory study were to identify Canadian and Belgian health professionals' beliefs and attitudes towards parental involvement in their child's ambulatory care and to determine if these beliefs varied according to cultural background. Health professionals from both countries generally were in favor of parental involvement in their child's care, but are uncertain about its advantages and disadvantages. Facilitators and barriers mentioned by the health care providers were related to parents' abilities or their attitudes toward partnership, and they also expressed a need for more education on the subject. Results of this study indicate that health professionals working in ambulatory care are not fully ready to utilize parents as true partners in their interventions with children and families. Staff education is an important step towards the establishment and maintenance of a real partnership.
Full Text Available A growing body of research in the field of health and social care indicates that the quality of the relationship between the person giving care and the person receiving it contributes significantly to the motivation and wellbeing of both. This paper examines how care workers’ motivation is shaped by their social and relational identification at work. Survey findings at two time points (T1, N = 643; T2, N = 1274 show that care workers’ motivation increases to the extent that incentives, the working context (of residential vs. domiciliary care, and the professionalization process (of acquiring vs. not acquiring a qualification serve to build and maintain meaningful identities within the organization. In this context care workers attach greatest importance to their relational identity with clients and the more they perceive this as congruent with their organizational identity the more motivated they are. Implications are discussed with regard to the need to develop and sustain a professional and compassionate workforce that is able to meet the needs of an ageing society.
Mirinaviciute, Grazina; Kristensen, Erle; Nakstad, Britt; Flem, Elmira
Norway does not currently implement universal varicella vaccination in childhood. We aimed to characterize health care burden of varicella in Norway in the prevaccine era. We linked individual patient data from different national registries to examine varicella vaccinations and varicella-coded primary care consultations, hospitalizations, outpatient hospital visits, deaths and viral infections of central nervous system in the whole population of Norway during 2008-2014. We estimated health care contact rates and described the epidemiology of medically attended varicella infection. Each year approximately 14,600 varicella-related contacts occurred within primary health care and hospital sector in Norway. The annual contact rate was 221 cases per 100,000 population in primary health care and 7.3 cases per 100,000 in hospital care. Both in primary and hospital care, the highest incidences were observed among children 1 year of age: 2,654 and 78.1 cases per 100,000, respectively. The annual varicella mortality was estimated at 0.06 deaths per 100,000 and in-hospital case-fatality rate at 0.3%. Very few (0.2-0.5%) patients were vaccinated against varicella. Among hospitalized varicella patients, 22% had predisposing conditions, 9% had severe-to-very severe comorbidities and 5.5% were immunocompromised. Varicella-related complications were reported in 29.3% of hospitalized patients. Varicella zoster virus was the third most frequent virus found among 16% of patients with confirmed viral infections of central nervous system. Varicella causes a considerable health care burden in Norway, especially among children. To inform the policy decision on the use of varicella vaccination, a health economic assessment of vaccination and mathematical modeling of vaccination impact are needed.
Chiu, Hui-Ying; Lin, Yu-Hua; Wang, Chin-Chou; Chen, Wan-Yi; Chang, Huang-Chih; Lin, Meng-Chih
Chemotherapy (CT) is the first priority treatment for advanced stage lung cancer. However, symptom distress, impaired ability to conduct daily activities, and post-CT care needs are potential side effects of CT. To explore the factors related to the care needs of post-chemotherapy lung cancer patients. A cross-sectional study was used. One hundred and twenty-one adult patients who had been diagnosed with advanced-stage lung cancer and who had undergone CT using the Platinum and Docetaxel doublet regimen were recruited from a medical center in southern Taiwan. The instruments used included a nursing care needs survey, symptoms distress scale, daily activity interference scale, and patient characteristics datasheet. Participants self-prioritized their emergency management, health consultation, and emotional support activities based on their perceived care needs. The top three post-CT symptoms in terms of severity were: fatigue, appetite change, and sleep disorder. Primary disruptions in daily activities during the post-CT period related to: holding social activities, work, and stair climbing. Significant and positive correlations were found among daily activity interference (r = .30, p needs. The regression model indicated daily activity interference as a predictor of care needs, accounting for 10.7% of the total variance. These results highlight the relationships among care needs, symptom distress, and daily activity interference in post-chemotherapy lung-cancer patients. The present study provides a reference for nursing care to reduce the symptom distress, to enhance the performance of daily activities, and to meet the care needs of lung-cancer patients.
Erichsén, E; Milberg, A; Jaarsma, T; Friedrichsen, M
For patients in palliative care, constipation is primarily a result of opioid treatment. Impacts from other factors related to constipation in palliative care are rarely studied. The aim was to identify factors related to constipation in patients in palliative care, and then to compare these factors between patients with different types of constipation and patients without constipation. Cross-sectional data on constipation was collected with a 26-item questionnaire from 485 patients in 38 specialist palliative care units in Sweden. Three different constipation groups were used; MC ONLY, PC ONLY, and MC & PC. Logistic regression analyses were used to calculate odds ratios. Patients with hospitalized, bed-restricted, in need of personal assistance for toilet visits, and of having a poor fluid intake. Patients with the perception of being constipated, PC ONLY, (n = 93) had higher odds of having poor appetite, hemorrhoids, hard stool, more opioid treatment, less laxative treatment and of being more dissatisfied with constipation information. Patients with both constipated, MC & PC, (n = 78) had higher odds of having cancer- disease. There were several significant factors related to constipation with higher odds than opioid- treatment, for patients in palliative care, such as; hard stool, cancer diagnosis, dissatisfaction with information, low fluid intake, hemorrhoids, bed restriction, hospitalization, and need of personal assistance for toilet visits.
Drijfhout, E.; Oeveren, J.C. van; Jansen, R.C.
A non-destructive method has been developed to select common bean (Phaseolus vulgaris L.) plants whose growth is less effected at a suboptimal temperature. Shoot weight was determined at a suboptimal (14°C) and optimal temperature (20°C), 38 days after sowing and accessions identified with a
Kommers, D.R.; Oei, S.G.; Chen, W.; Feijs, L.M.G.; Bambang Oetomo, S.
This review aimed to raise awareness of the consequences of suboptimal bonding caused by prematurity. In addition to hypoxia–ischaemia, infection and malnutrition, suboptimal bonding is one of the many unnatural stimuli that preterm infants are exposed to, compromising their physiological
McHale, Calum T; Laidlaw, Anita H; Cecil, Joanne E
Primary care is ideally placed to play an effective role in patient weight management; however, patient weight is seldom discussed in this context. A synthesis of studies that directly observe weight discussion in primary care is required to more comprehensively understand and improve primary care weight-related communication. To systematically identify and examine primary care observational research that investigates weight-related communication and its relationship to patient weight outcomes. A systematic review of literature published up to August 2015, using seven electronic databases (including MEDLINE, Scopus and PsycINFO), was conducted using search terms such as overweight, obese and/or doctor-patient communication. Twenty papers were included in the final review. Communication analysis focused predominantly on 'practitioner' use of specific patient-centred communication. Practitioner use of motivational interviewing was associated with improved patient weight-related outcomes, including patient weight loss and increased patient readiness to lose weight; however, few studies measured patient weight-related outcomes. Studies directly observing weight-related communication in primary care are scarce and limited by a lack of focus on patient communication and patient weight-related outcomes. Future research should measure practitioner and patient communications during weight discussion and their impact on patient weight-related outcomes. This knowledge may inform the development of a communication intervention to assist practitioners to more effectively discuss weight with their overweight and/or obese patients. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: email@example.com.
Hirata, Hiromi; Harvath, Theresa A
The purpose of this study was to explore Japanese care workers' attributions, beliefs and cultural explanations of physically and psychologically aggressive behaviour symptoms. Physically and psychologically aggressive behaviour symptoms by older people with dementia have been associated with occupational stress among care workers in the United States and other Western countries and may contribute to staff turnover. However, few studies related to this issue have been conducted in Japan, where care worker reaction to physically and psychologically aggressive behaviour symptoms might be different because of cultural and customary differences in how care is provided for older people. This study reports on the results of three open-ended questions that were part of a larger study that explored Japanese care workers' experiences with aggressive behaviour symptoms in persons with dementia. Convenience sampling was used to recruit 137 care workers in 10 nursing homes in the northern and western areas of Japan. The answers to the open-ended questions were analysed using a content analysis. Most of the participants indicated that they believed that physically and psychologically aggressive behaviour symptoms came from residents' stress from dementia. Approximately, one-fourth of the participants responded that Japanese values such as chu (loyalty) and joge (hierarchy) influenced their work with residents with physically and psychologically aggressive behaviour symptoms. Seventeen participants (12%) commented either that they respected older people or that they respected older people as persons who had had many experiences in life. Interestingly, 43 responses (41.0%) indicated that physically and psychologically aggressive behaviour symptoms influenced quality of care positively, while, not surprisingly, about 30 responses indicated that those behaviour symptoms influenced quality of care negatively. Findings from this study indicate that the training and education needs to
Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca; Brinkman, William B; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua M
The development of attention-deficit/hyperactivity disorder (ADHD) care quality measurements is a prerequisite to improving the quality of community-based pediatric care of children with ADHD. Unfortunately, the evidence base for existing ADHD care quality metrics is poor. The objective of this study was to identify which components of ADHD care best predict patient outcomes. Parents of 372 medication-naïve children in grades 1 to 5 presenting to their community-based pediatrician (N = 195) for an ADHD-related concern and who were subsequently prescribed ADHD medication were identified. Parents completed the Vanderbilt ADHD Parent Rating Scale (VAPRS) at the time ADHD was raised as a concern and then approximately 12 months after starting ADHD medication. Each patient's chart was reviewed to measure 12 different components of ADHD care. Across all children, the mean decrease in VAPRS total symptom score during the first year of treatment was 11.6 (standard deviation 10.1). Of the 12 components of ADHD care, shorter times to first contact and more teacher ratings collected in the first year of treatment significantly predicted greater decreases in patient total symptom scores. Notably, it was timeliness of contacts, defined as office visits, phone calls, or email communication, that predicted more ADHD symptom decreases. Office visits alone, in terms of number or timeliness, did not predict patient outcomes. The magnitude of ADHD symptom decrease that can be achieved with the use of ADHD medications was associated with specific components of ADHD care. Future development and modifications of ADHD quality care metrics should include these ADHD care components. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Ahmad Nizaruddin M
Full Text Available Mariani Ahmad Nizaruddin, Marhanis-Salihah Omar, Adliah Mhd-Ali, Mohd Makmor-Bakry Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Background: Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs.Participants and methods: A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner.Results and discussion: Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents’ medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes.Conclusion: There are important issues
Full Text Available Abstract Background Very little research has explored the factors that influence interest in complementary and alternative medicine (CAM treatments. We surveyed persons with sub-optimally controlled type 2 diabetes to evaluate potential relationships between interest in complementary and alternative medicine (CAM treatments, current self-care practices, motivation to improve self-care practices and satisfaction with current health care for diabetes. Methods 321 patients from a large integrated healthcare system with type 2 diabetes, who were not using insulin and had hemoglobin A1c values between 7.5-9.5%, were telephoned between 2009-2010 and asked about their self-care behaviors, motivation to change, satisfaction with current health care and interest in trying naturopathic (ND care for their diabetes. Responses from patients most interested in trying ND care were compared with those from patients with less interest. Results 219 (68.5% patients completed the survey. Nearly half (48% stated they would be very likely to try ND care for their diabetes if covered by their insurance. Interest in trying ND care was not related to patient demographics, health history, clinical status, or self-care behaviors. Patients with greater interest in trying ND care rated their current healthcare as less effective for controlling their blood sugar (mean response 5.9 +/- 1.9 vs. 6.6 +/- 1.5, p = 0.003, and were more determined to succeed in self-care (p = 0.007. Current CAM use for diabetes was also greater in ND interested patients. Conclusions Patients with sub-optimally controlled type 2 diabetes expressed a high level of interest in trying ND care. Those patients with the greatest interest were less satisfied with their diabetes care, more motivated to engage in self-care, and more likely to use other CAM therapies for their diabetes.
Herranz, R.; Benguría, A.; Laván, D.A.; López-Vidriero, I.; Gasset, G.; Javier Medina, F.; van Loon, J.J.W.A.; Marco, R.
Genome-wide transcriptional profiling shows that reducing gravity levels during Drosophila metamorphosis in the International Space Station (ISS) causes important alterations in gene expression: a large set of differentially expressed genes (DEGs) are observed compared to 1g controls. However, the
Ana Carolina Coimbra de Castro
Full Text Available Objective: To identify the prevalence of bloodstream infection associated with the Catheter related Blood stream infections in patients of the Intensive Care Unit, and the characteristics of its use and handling. Methods: Descriptive and transversal study with a sample of 88 participants. Data were collected through the observational method and the records in the medical records. The absolute and relative frequencies were used for data analysis. Results: 73.86% of the patients had central venous access in the subclavian vein, 100% used double lumen Catheter related Blood stream infections, 0.5% chlorhexidine solution for skin antisepsis, dressing coverage is performed mostly with Sterile gauze and tape, with a daily exchange. The rate of infection related to the use of the Catheter related Blood stream infections was (6.81%. The most infused pharmacological drugs were antimicrobials (69.32%. Conclusion: The study showed that care with central venous accesses is performed according to recommendations for prevention of bloodstream infection related to the use of these devices. The infection rate is close to the standards found in the literature. Key words: Central Venous Catheterization. Hospital Infection. Intensive care unit. Risk factors. Catheter-Related Infection..
Coyer, Fiona M; Stotts, Nancy A; Blackman, Virginia Schmied
The aim of this study was to determine the prevalence, severity, location, aetiology, treatment and healing of medical device-related pressure ulcers (PUs) in intensive care patients for up to 7 days. A prospective repeated measures study design was used. Patients in six intensive care units of two major medical centres, one each in Australia and the USA, were screened 1 day per month for 6 months. Those with device-related ulcers were followed daily for up to 7 days. The outcome measures were device-related ulcer prevalence, pain, infection, treatment and healing. Fifteen of 483 patients had device-related ulcers and 9 of 15 with 11 ulcers were followed beyond screening. Their mean age was 60·5 years, and most were men, overweight and at increased risk of PU. Endotracheal (ET) and nasogastric (NG) tubes were the cause of most device-related ulcers. Repositioning was the most frequent treatment. Four of 11 ulcers healed within the 7-day observation period. In conclusion, device-related ulcer prevalence was 3·1%, similar to that reported in the limited literature available, indicating an ongoing problem. Systematic assessment and repositioning of devices are the mainstays of care. We recommend continued prevalence determination and that nurses remain vigilant to prevent device-related ulcers, especially in patients with NG and ET tubes. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.
Bauer, Sarah E; Schumacher, Jessica R; Hall, Allyson; Marlow, Nicole M; Friedel, Claudia; Scheer, Danielle; Redmon, Susan
Research has not fully characterized barriers to health care faced by persons with disabilities (PWD) which constitutes a critical gap given the increased risk of chronic illness faced by PWD. To understand the current barriers to seeking health care-related services for PWD in Florida. The study was based on a random-digit-dial telephone interview survey of respondents aged 18 and over (n = 1429). Multivariable logistic regression assessed the relationship between disability and physical and communication barriers. One thousand four hundred and twenty-nine Florida residents participated in the survey. Thirty-three percent of respondents (n = 471) reported having a disability. PWD were significantly older (mean age 68 vs. 61) and had lower levels of income and education than persons without disabilities (PWOD) (p barrier (Odds Ratio [OR] = 16.6 95% CI: 7.9, 34.9), a clinical experience barrier (OR = 13.9 95% CI: 6.9, 27.9) a communication and knowledge barrier (OR = 6.7 95% CI: 4.0, 11.3) and a barrier coordinating care (OR = 5.7 95% CI: 3.4, 9.6) compared to persons without disabilities (PWOD). PWD disproportionately face health care access difficulties that can impede the receipt of high quality care within and between provider visits. Efforts to reduce physical barriers and improve communication between providers and PWD may improve functional status and quality of life for these patients. Copyright © 2016 Elsevier Inc. All rights reserved.
Jones, P. W.; Brusselle, G.; Dal Negro, R. W.; Ferrer, M.; Kardos, P.; Levy, M. L.; Perez, T.; Soler-Cataluna, J. J.; van der Molen, T.; Adamek, L.; Banik, N.
Pan-European data on health-related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD) are lacking. This cross-sectional epidemiological study evaluated health status in 1817 COPD patients from an 'all-comers' primary care population in seven European countries (87% stable
Smit, Brigitte; Scherman, Vanessa
This paper attends to a theoretical exposition of relational leadership and ethics care as complementary approaches to educational leadership in counteracting bullying at schools. Schools constitute complex systems of activities, processes and dynamics. More specifically, a social system in schools is a web of interactions between the various…
van Vugt, E.; Lanctôt, N.; Paquette, G.; Collin-Vezina, D.; Lemieux, A.
The current study examined the association between child maltreatment and trauma-related symptoms in emerging adulthood - over and above the incidence of such symptoms and conduct problems during adolescence - among a sample of female adolescents in residential care. This study used data from a
Benjamin, A. E.; Matthias, Ruth E.; Kietzman, Kathryn; Furman, Walter
Purpose: The use of consumer-directed services is expected to grow in coming years, and paying family and friends is a key element of these home-based services. The goal of this study was to understand the careers of these "related workers" (family and friends) and their potential role in the long-term care workforce. Design and Methods:…
Kosse, Nienke M.; de Groot, Maartje H.; Vuillerme, Nicolas; Hortobagyi, Tibor; Lamoth, Claudine J. C.
Background: Falls in long-term care residents with dementia represent a costly but unresolved safety issue. The aim of the present study was to (1) determine the incidence of falls, fall-related injuries and fall circumstances, and (2) identify the relationship between patient characteristics and
Purpose: Almost half of people age 85 and older who die annually in the United States die as nursing home residents, yet because it is not always clear who is close to death, not all residents who might benefit from end-of-life care receive it. The purpose of this study is to develop a framework for organizing social interactions related to…
This paper attends to a theoretical exposition of relational leadership and ethics care as complementary approaches to educational leadership in counteracting bullying at schools. Schools constitute complex systems of activities, processes and dynamics. More specifically, a social system in schools is a web of interactions ...
Phillips, Beth M.; Morse, Erika E.
This paper presents findings from a stratified-random survey of family child care providers' backgrounds, caregiving environments, practices, attitudes, and knowledge related to language, literacy, and mathematics development for preschool children. Descriptive results are consistent with prior studies suggesting that home-based providers are…
Douma, Johanna G.; Volkers, Karin M.; Engels, Gwenda; Sonneveld, Marieke H.; Goossens, Richard H. M.; Scherder, Erik J. A.
Background: Despite the detrimental effects of physical inactivity for older adults, especially aged residents of residential care settings may spend much time in inactive behavior. This may be partly due to their poorer physical condition; however, there may also be other, setting-related factors
Zhang, Xiao Cui; Liu, Yu Mei; Bai, Long Qiang; He, Chao Xing; Yu, Xian Chang; Li, Yan Su
Cucumber (cv. Zhongnong 26) was used as material, the effects of NO 3 - -N/NH 4 + -N ratios on growth and physiological characteristics of cucumber seedlings under suboptimal temperature and light intensity (18 ℃/10 ℃,180 ± 20 μmol·m -2 ·s -1 ) were studied. Total nitrogen in the nutrient solution was equal and three NO 3 - -N/NH 4 + -N ratios, 26:2, 21:7 and 14:14, were applied as treatments. The results showed that cucumber treated by NO 3 - -N/NH 4 + -N=21:7 had the longest total root length, the biggest root volume and root surface area, and the maximum number of root tips. H + -ATPase activity and relative expression of genes encoding nitrate transporter (NRT) and ammonium transporter (AMT) in cucumber roots were increased significantly by the treatment of NO 3 - -N/NH 4 + -N=21:7. In addition, nitrate reductase (NR), glutamine synthetase (GS) and glutamate synthase (GOGAT) in cucumber leaves under the treatment of NO 3 - -N/NH 4 + -N=21:7 were higher. As a result, the nitrogen content and biomass of cucumber were significantly increased. Compared with the plants under the treatment of NO 3 - -N/NH 4 + -N=26:2 or 14:14, cucumber seedlings under the treatment of NO 3 - -N/NH 4 + -N=21:7 had the highest biomass and total dry mass (DM) which were increased by 14.0% and 19.3% respectively under suboptimal temperature and light intensity. In conclusion, under suboptimal environmental conditions, NO 3 - -N/NH 4 + -N ratio could be adjusted to increase nitrogen absorption and metabolism of cucumber and alleviate the de-trimental effects caused by suboptimal conditions and promoted the cucumber growth.
Ferrie, Jane E; Kivimäki, Mika; Westerlund, Hugo; Head, Jenny; Melchior, Maria; Singh-Manoux, Archana; Zins, Marie; Goldberg, Marcel; Alexanderson, Kristina; Vahtera, Jussi
Although sickness absence is a strong predictor of health, whether this association varies by occupational position has rarely been examined. The aim of this study was to investigate overall and diagnosis-specific sickness absence as a predictor of future long-term sub-optimal health by occupational position. This was a prospective occupational cohort study of 15 320 employees (73% men) aged 37-51. Sickness absences (1990-1992), included in 13 diagnostic categories, were examined by occupational position in relation to self-rated health measured annually during 1993-2006. 60% of employees in higher occupational positions and 22% in lower positions had no sickness absence. Conversely, 9.5% of employees in higher positions and 40% in lower positions had over 30 sick-leave days. Repeated-measures logistic regression analyses adjusted for age, sex and chronic disease showed employees with over 30 days absence, compared to those with no absence, had approximately double the risk of sub-optimal health over the 14-year follow-up in all occupational positions. 1-30 days sick-leave was associated with greater odds of sub-optimal health in the high (OR 1.48; 95% CI 1.27 to 1.72) and intermediate (1.29; 1.15 to 1.45) but not lower occupational positions (1.06; 0.82 to 1.38). Differences by occupational position in the association between sickness absence in 13 specific diagnostic categories and sub-optimal health over the ensuing 14 years were limited to stronger associations observed with cancer and mental disorders in the higher occupational positions. The association between sickness absence of more than 30 days over 3 years and future long-term self-rated health appears to differ little by occupational position.
Fox, Ann; Reeves, Scott
There has been sustained international interest from health care policy makers, practitioners, and researchers in developing interprofessional approaches to delivering patient-centred care. In this paper, we offer a critical exploration of a selection of professional discourses related to these practice paradigms, including interprofessional collaboration, patient-centred care, and the combination of the two. We argue that for some groups of patients, inequalities between different health and social care professions and between professionals and patients challenge the successful realization of the positive aims associated with these discourses. Specifically, we argue that interprofessional and professional-patient hierarchies raise a number of key questions about the nature of professions, their relationships with one another as well as their relationship with patients. We explore how the focus on interprofessional collaboration and patient-centred care have the potential to reinforce a patient compliance model by shifting responsibility to patients to do the "right thing" and by extending the reach of medical power across other groups of professionals. Our goal is to stimulate debate that leads to enhanced practice opportunities for health professionals and improved care for patients.
Irinyi, Tamás; Németh, Anikó; Lampek, Kinga
Violence against health care providers is getting more awareness nowadays. This topic is in the focus of international scientific attention also, although in Hungary exact data is lacking. The present study aimed to assess the correlations between violent acts against health care workers and their effects with different sociodemographic and workplace-related factors. A quantitative cross-sectional online survey was conducted enrolling 1201 health care providers. Data were analysed trough chi-square, Kolmogorov-Smirnov, Mann-Whitney and Kruskal-Wallis tests, where appropriate. Verbal and physical aggression was experienced more frequently by nurses who were males, above the age of fifty, working in in-patient care or in 12 hours shifts or constant night shifts. The same groups of health care providers suffered more from the negative emotional consequences of violent acts. Aggression is a serious problem in the Hungarian health care system, therefore employees have to be prepared for these acts. Orv. Hetil., 2017, 158(6), 229-237.
Full Text Available This paper focuses on the efficiency of target-company investment decisions before and after Merger & Acquisition deals. We study whether M&A deals help to solve the problem of suboptimal investment after the acquisition. Using a sample of 145 target companies from BRICS countries that were acquired during the period 2004-2014, we outline those that had over- or underinvested before the deal and show that more than half the companies managed to optimize the investment level after the deal. We determine the key factors that improve the inefficiency of investment decisions and demonstrate that the industry and country have an impact on the degree of suboptimal investment.
Full Text Available Active interference cancellation (AIC is an effective technique to provide interference avoidance feature for an ultrawideband (UWB OFDM transmitter. Partial transmit sequence-AIC (PTS-AIC, which was recently proposed as an improvement of AIC, requires high computational complexity by doing the exhaustive search of all possible weighting factors whose number grows exponentially with the number of subblocks used. To reduce the complexity of PTS-AIC, this paper proposes a suboptimal way, called particle swarm optimization (PSO, to choose the weighting factors suboptimally without much performance degradation. Both continuous and discrete versions of PSO have been evaluated, and it has been shown that the discrete PSO is able to reduce the complexity significantly without sacrificing the performance of PTS-AIC in many cases.
Walsh, Carolyn O; Milliren, Carly E; Feldman, Henry A; Taveras, Elsie M
To determine referral patterns from pediatric primary care to subspecialists for overweight/obesity and related comorbidities. We used the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to identify overweight/obesity and 5 related comorbidities in primary care visits between 2005 and 2009 by children 6 to 18 years. The primary outcome was whether the visit ended in referral. We used multivariable analysis to examine factors associated with referral. We identified 34,225 database visits. A total of 17.1% were with overweight (body mass index=85th to 94th percentile) or obese (body mass index≥95th percentile) patients. A total of 7.1% of primary care visits with overweight/obese children ended in referral. Referral was more likely when obesity was the reason for visit (odds ratio=2.83; 95% confidence interval=1.61-4.97) but was not associated with presence of a comorbidity (odds ratio=1.35; 95% confidence interval=0.75-2.44). Most overweight or obese children are not referred, regardless of comorbidity status. One reason may be low levels of appropriate diagnosis.
Ahmad Nizaruddin, Mariani; Omar, Marhanis-Salihah; Mhd-Ali, Adliah; Makmor-Bakry, Mohd
Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs). A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner. Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents' medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes. There are important issues related to medication management in RACFs which require a need to establish policy and guidelines.
Rubin, Geoffrey D
Costs direct decisions that influence the effectiveness of radiology in the care of patients on a daily basis. Yet many radiologists struggle to harness the power of cost measurement and cost management as a critical path toward establishing their value in patient care. When radiologists cannot articulate their value, they risk losing control over how imaging is delivered and supported. In the United States, recent payment trends directing value-based payments for bundles of care advance the imperative for radiology providers to articulate their value. This begins with the development of an understanding of the providers' own costs, as well as the complex interrelationships and imaging-associated costs of other participants across the imaging value chain. Controlling the costs of imaging necessitates understanding them at a procedural level and quantifying the costs of delivering specific imaging services. Effective product-level costing is dependent on a bottom-up approach, which is supported through recent innovations in time-dependent activity-based costing. Once the costs are understood, they can be managed. Within the high fixed cost and high overhead cost environment of health care provider organizations, stakeholders must understand the implications of misaligned top-down cost management approaches that can both paradoxically shift effort from low-cost workers to much costlier professionals and allocate overhead costs counterproductively. Radiology's engagement across a broad spectrum of care provides an excellent opportunity for radiology providers to take a leading role within the health care organizations to enhance value and margin through principled and effective cost management. Following a discussion of the rationale for measuring costs, this review contextualizes costs from the perspectives of a variety of stakeholders (relativity), discusses core concepts in how costs are classified (rudiments), presents common and improved methods for measuring
Dijkstra, Ate; Hakverdioğlu, Gülendam; Muszalik, Marta; Andela, Richtsje; Korhan, Esra Akın; Kędziora-Kornatowska, Kornelia
Many countries in Europe and the world have to cope with an aging population. Although health policy in many countries aims at increasing disability-free life expectancy, elderly patients represent a significant proportion of all patients admitted to different hospital departments. The aim of the research was to investigate the relationship between health-related quality of life (HRQOL) and the care dependency status among elderly hospital patients. In 2012, a descriptive survey was administered to a convenience sample of 325 elderly hospital patients (> 60 years) from The Netherlands (N = 125), from Poland (N = 100), and from Turkey (N = 100). We employed the Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System and the Care Dependency Scale. FACIT is a collection of HRQOL questionnaires that assess multidimensional health status in people with various chronic illnesses. From demographic variables, gender (female) (r = -0.13, p < 0.05), age and informal care given by family members (r = -0.27 to 0.27, p < 0.01) were significantly correlated with the care dependency status for the whole samples. All HRQOL variables, hearing aid and duration of illness correlated with care dependency status (r = -0.20 to 0.50, p < 0.01). Moreover, the FACIT sum score (Poland and Turkey) and functional wellbeing (The Netherlands) are significantly associated with the decrease in care dependency status. Thus, the FACIT variables are the most powerful indicators for care dependency. The study provides healthcare professionals insight into improvement of quality of care in all three countries.
Gittell, Jody Hoffer; Beswick, Joanne; Goldmann, Don; Wallack, Stanley S
To deliver greater value in the accountable care context, the Institute of Medicine argues for a culture of teamwork at multiple levels--across professional and organizational siloes and with patients and their families and communities. The logic of performance improvement is that data are needed to target interventions and to assess their impact. We argue that efforts to build teamwork will benefit from teamwork measures that provide diagnostic information regarding the current state and teamwork interventions that can respond to the opportunities identified in the current state. We identify teamwork measures and teamwork interventions that are validated and that can work across multiple levels of teamwork. We propose specific ways to combine them for optimal effectiveness. We review measures of teamwork documented by Valentine, Nembhard, and Edmondson and select those that they identified as satisfying the four criteria for psychometric validation and as being unbounded and therefore able to measure teamwork across multiple levels. We then consider teamwork interventions that are widely used in the U.S. health care context, are well validated based on their association with outcomes, and are capable of working at multiple levels of teamwork. We select the top candidate in each category and propose ways to combine them for optimal effectiveness. We find relational coordination is a validated multilevel teamwork measure and TeamSTEPPS® is a validated multilevel teamwork intervention and propose specific ways for the relational coordination measure to enhance the TeamSTEPPS intervention. Health care systems and change agents seeking to respond to the challenges of accountable care can use TeamSTEPPS as a validated multilevel teamwork intervention methodology, enhanced by relational coordination as a validated multilevel teamwork measure with diagnostic capacity to pinpoint opportunities for improving teamwork along specific dimensions (e.g., shared knowledge
K. B. Baltzis
Full Text Available Generalized RAKE (G-RAKE reception reduces the total amount of interference and provides enhanced diversity by comprising extra fingers to collect information about interference and further using channel and impairment correlation estimates for fingers allocation. However, the hardware complexity and the excessive computational requirements of GRAKE receivers may restrict their application in real systems; thus, suboptimal solutions are commonly used. In this paper, we propose and evaluate three maximum likelihood G-RAKE structures for colored noise with suboptimal finger placement. In all implementations, the fingers are optimally distributed within a time window that spans from several chip periods before the first arriving multipath to several chip periods after the latest one. The first receiver has its fingers at integer multiples of the chip period while in the rest two structures the search window is segmented in halves and tenths of the chip duration. This work also extends earlier studies by thoroughly investigating the impact of fractionally spaced finger placement on system performance. Our analysis shows that a suboptimal finger allocation reduces hardware complexity with negligible performance loss. The impact of channel delay spread and processing gain on system performance is also investigated and gives interesting results.
Sánchez-Vallejo, A; Fernández, D; Pérez-Gutiérrez, A; Fernández-Fernández, M
To describe the needs of the families of patients admitted to the Intensive Care Unit (ICU) and the opinion of ICU professionals on aspects related to the presence of patient relatives in the unit. A prospective descriptive study was carried out between March and June 2015. Polyvalent ICU of León University Healthcare Complex (Spain). Two samples of volunteers were studied: one comprising the relatives emotionally closest to the primarily non-surgical patients admitted to the Unit for over 48hours, and the other composed of ICU professionals with over three months of experience in the ICU. One self-administered questionnaire was delivered to each relative and another to each professional. Sociodemographic data were collected. The variables in the questionnaire for relatives comprised the information received, closeness to the patient, safety of care, the support received, and comfort. In turn, the questionnaire for professionals addressed empathy and professional relationship with the family, visiting policy, and the effect of the family upon the patient. A total of 59% of the relatives (35/61) answered the questionnaire. Of these subjects, 91.4% understood the information received, though 49.6% received no information on nursing care. A total of 82.9% agreed with the visiting policy applied (95.2% were patient offspring; P<.05). Participation on the part of the professionals in turn reached 76.3% (61/80). A total of 59.3% would flexibilize the visiting policy, and 78.3% considered that the family afforded emotional support for the patient, with no destabilizing effect. On the other hand, 62.3% routinely informed the family, and 88% considered training in communication skills to be needed. Information was adequate, though insufficient in relation to nursing care. The professionals pointed to the need for training in communication skills. Copyright Â© 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Liu, Yun-E; While, Alison; Li, Shu-Jun; Ye, Wen-Qin
To explore critical care nurses' views of their job satisfaction and the relationship with job burnout, practice environment, coping style, social support, intention to stay in current employment and other work-related variables. Nurse shortage is a global issue, especially in critical care. Job satisfaction is the most frequently cited factor linked to nurses' turnover. A convenience sample of cardiac critical care nurses (n = 215; 97.7% response rate) from 12 large general hospitals in Shanghai was surveyed from December 2010 to March 2011. Over half of the sample reported satisfaction with their jobs. Nurses with 10-20 years of professional experience and those who had taken all their holiday entitlement reported higher levels of job satisfaction. The independent variables of practice environment, intention to stay, emotional exhaustion, personal accomplishment and positive coping style explained about 55% of the variance in job satisfaction. Chinese cardiac critical care nurses' job satisfaction was related to work related variables, which are amenable to managerial action. Our findings highlight the imperative of improving intrinsic and extrinsic rewards, together with the flexibility of work schedules to promote job satisfaction and staff retention. A clinical ladder system is needed to provide promotion opportunities for Chinese nurses. © 2013 John Wiley & Sons Ltd.
Moore, Kevin L.; Schmidt, Rachel; Moiseenko, Vitali; Olsen, Lindsey A.; Tan, Jun; Xiao, Ying; Galvin, James; Pugh, Stephanie; Seider, Michael J.; Dicker, Adam P.; Bosch, Walter; Michalski, Jeff; Mutic, Sasa
Purpose: The purpose of this study was to quantify the frequency and clinical severity of quality deficiencies in intensity modulated radiation therapy (IMRT) planning in the Radiation Therapy Oncology Group 0126 protocol. Methods and Materials: A total of 219 IMRT patients from the high-dose arm (79.2 Gy) of RTOG 0126 were analyzed. To quantify plan quality, we used established knowledge-based methods for patient-specific dose-volume histogram (DVH) prediction of organs at risk and a Lyman-Kutcher-Burman (LKB) model for grade ≥2 rectal complications to convert DVHs into normal tissue complication probabilities (NTCPs). The LKB model was validated by fitting dose-response parameters relative to observed toxicities. The 90th percentile (22 of 219) of plans with the lowest excess risk (difference between clinical and model-predicted NTCP) were used to create a model for the presumed best practices in the protocol (pDVH 0126,top10% ). Applying the resultant model to the entire sample enabled comparisons between DVHs that patients could have received to DVHs they actually received. Excess risk quantified the clinical impact of suboptimal planning. Accuracy of pDVH predictions was validated by replanning 30 of 219 patients (13.7%), including equal numbers of presumed “high-quality,” “low-quality,” and randomly sampled plans. NTCP-predicted toxicities were compared to adverse events on protocol. Results: Existing models showed that bladder-sparing variations were less prevalent than rectum quality variations and that increased rectal sparing was not correlated with target metrics (dose received by 98% and 2% of the PTV, respectively). Observed toxicities were consistent with current LKB parameters. Converting DVH and pDVH 0126,top10% to rectal NTCPs, we observed 94 of 219 patients (42.9%) with ≥5% excess risk, 20 of 219 patients (9.1%) with ≥10% excess risk, and 2 of 219 patients (0.9%) with ≥15% excess risk. Replanning demonstrated the predicted NTCP
Moore, Kevin L; Schmidt, Rachel; Moiseenko, Vitali; Olsen, Lindsey A; Tan, Jun; Xiao, Ying; Galvin, James; Pugh, Stephanie; Seider, Michael J; Dicker, Adam P; Bosch, Walter; Michalski, Jeff; Mutic, Sasa
The purpose of this study was to quantify the frequency and clinical severity of quality deficiencies in intensity modulated radiation therapy (IMRT) planning in the Radiation Therapy Oncology Group 0126 protocol. A total of 219 IMRT patients from the high-dose arm (79.2 Gy) of RTOG 0126 were analyzed. To quantify plan quality, we used established knowledge-based methods for patient-specific dose-volume histogram (DVH) prediction of organs at risk and a Lyman-Kutcher-Burman (LKB) model for grade ≥2 rectal complications to convert DVHs into normal tissue complication probabilities (NTCPs). The LKB model was validated by fitting dose-response parameters relative to observed toxicities. The 90th percentile (22 of 219) of plans with the lowest excess risk (difference between clinical and model-predicted NTCP) were used to create a model for the presumed best practices in the protocol (pDVH0126,top10%). Applying the resultant model to the entire sample enabled comparisons between DVHs that patients could have received to DVHs they actually received. Excess risk quantified the clinical impact of suboptimal planning. Accuracy of pDVH predictions was validated by replanning 30 of 219 patients (13.7%), including equal numbers of presumed "high-quality," "low-quality," and randomly sampled plans. NTCP-predicted toxicities were compared to adverse events on protocol. Existing models showed that bladder-sparing variations were less prevalent than rectum quality variations and that increased rectal sparing was not correlated with target metrics (dose received by 98% and 2% of the PTV, respectively). Observed toxicities were consistent with current LKB parameters. Converting DVH and pDVH0126,top10% to rectal NTCPs, we observed 94 of 219 patients (42.9%) with ≥5% excess risk, 20 of 219 patients (9.1%) with ≥10% excess risk, and 2 of 219 patients (0.9%) with ≥15% excess risk. Replanning demonstrated the predicted NTCP reductions while maintaining the volume of the PTV
Rensen, Ans; van Mol, Margo M; Menheere, Ilse; Nijkamp, Marjan D; Verhoogt, Ellen; Maris, Bea; Manders, Willeke; Vloet, Lilian; Verharen, Lisbeth
The quality standards of the Dutch Society of Intensive Care require monitoring of the satisfaction of patient's relatives with respect to care. Currently, no suitable instrument is available in the Netherlands to measure this. This study describes the development and psychometric evaluation of the questionnaire-based Consumer Quality Index 'Relatives in Intensive Care Unit' (CQI 'R-ICU'). The CQI 'R-ICU' measures the perceived quality of care from the perspective of patients' relatives, and identifies aspects of care that need improvement. The CQI 'R-ICU' was developed using a mixed method design. Items were based on quality of care aspects from earlier studies and from focus group interviews with patients' relatives. The time period for the data collection of the psychometric evaluation was from October 2011 until July 2012. Relatives of adult intensive care patients in one university hospital and five general hospitals in the Netherlands were approached to participate. Psychometric evaluation included item analysis, inter-item analysis, and factor analysis. Twelve aspects were noted as being indicators of quality of care, and were subsequently selected for the questionnaire's vocabulary. The response rate of patients' relatives was 81% (n = 455). Quality of care was represented by two clusters, each showing a high reliability: 'Communication' (α = .80) and 'Participation' (α = .84). Relatives ranked the following aspects for quality of care as most important: no conflicting information, information from doctors and nurses is comprehensive, and health professionals take patients' relatives seriously. The least important care aspects were: need for contact with peers, nuisance, and contact with a spiritual counsellor. Aspects that needed the most urgent improvement (highest quality improvement scores) were: information about how relatives can contribute to the care of the patient, information about the use of meal-facilities in the hospital, and
"Citizenship" is a term from political theory. The term has moved from the relationship between the individual and the state toward addressing the position of 'others' in society. Here, I am concerned with people with long-term mental health problems. I explore the possibilities of ethnographically studying this rather more cultural understanding of citizenship with the use of the concept of relational citizenship, attending to people who leave Dutch institutions for mental health care. Relational citizenship assumes that people become citizens through interactions, whereby they create particular relations and social spaces. Rather than studying the citizen as a particular individual, citizenship becomes a matter of sociality. In this article, I consider what social spaces these relationships create and what values and mechanisms keep people together. I argue that the notion of neighborhood as a form of community, although built implicitly or explicitly into mental health care policy, is no longer the most plausible model to understand social spaces.
Bawa, Harpreet S; Weick, Jack W; Dirschl, Douglas R
Women older than 50 years have higher prevalence of knee osteoarthritis (OA) and experience greater functional disability than men. No studies have examined large populations to identify knee OA-related health care utilization differences. The purpose of this investigation was to evaluate gender differences in the utilization of OA-related health care resources in the 12 months preceding total knee arthroplasty (TKA). Truven Health MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefit databases were reviewed from 2005 to 2012. Subjects were included if they underwent TKA, had associated diagnosis of lower leg OA, and were continuously in the database for 12 months preceding TKA. Patient-specific OA-related health care utilization was identified. Multivariate logistic regression analysis controlling for age, region, and Charlson Comorbidity Index was performed to isolate the influence of gender. A total of 244,059 patients with a mean age of 64.8 years consisting of 61.2% women were included. Multivariate logistic regression adjusted odds ratios showed that when compared to men, women were 30%, 20%, 31%, 18%, 19%, 29%, and 39%, more likely to receive a narcotic analgesic, nonnarcotic analgesics, corticosteroid injection, hyaluronic acid injection, knee magnetic resonance imaging, a physical therapy evaluation, and occupational therapy evaluation in the 12 months preceding TKA, respectively. Women have a significantly higher utilization of knee OA-related health care in the 12 months preceding TKA. Although the precise cause for this discrepancy in care cannot be determined from this study, it highlights a potential bias in management of advanced knee OA and directions for further investigation. Copyright © 2016 Elsevier Inc. All rights reserved.
Tol, Jacqueline; Swinkels, Ilse C; De Bakker, Dinny H; Veenhof, Cindy; Seidell, Jaap C
BACKGROUND: The prevalence of obesity is growing worldwide. Obesity guidelines recommend increasing the level of weight-related care for persons with elevated levels of weight-related health risk (WRHR). However, there seems to be a discrepancy between need for and use of weight-related care. The
Jacobi, Catharina E.; Mol, Geert D.; Boshuizen, Hendriek C.; Rupp, Ines; Dinant, Huibert J.; van den Bos, Geertrudis A. M.
Objective. To quantify the impact of socioeconomic status (SES) among patients with rheumatoid arthritis on 1) health outcomes and related health care utilization in relation to disease duration and 2) changes in health outcomes and related health care utilization over a 2-year period. Methods. A
Baquedano, Irasema Romero; dos Santos, Manoel Antônio; Teixeira, Carla Regina de Souza; Martins, Tatiane Aparecida; Zanetti, Maria Lúcia
This cross-sectional study aimed to determine the self-care ability of individuals with type 2 diabetes mellitus and to relate this capacity with some sociodemographic and clinical variables. Participants were 251 patients who attended the Emergency Service at the Mérida Regional Hospital in Yucatán, Mexico, in 2006. Data were obtained through directed home interviews, using a form, a questionnaire and the Self-Care Capacity Scale. Descriptive and correlation statistics were used for data analysis. The results showed 83 (33.5%) subjects with good and 168 (66.5%) subjects with regular ability. A directly proportional correlation was found between self-care ability and years of study (r = 0.124; p diabetes patients, and further research needs to be developed with a focus on other variables involved in the behavior adopted to benefit their health.
Pia, Seppänen; Reijo, Sund; Tero, Ala-Kokko; Mervi, Roos; Jukka, Uotila; Mika, Helminen; Tarja, Suominen
Intensive care admissions during pregnancy, childbirth, and postpartum period are relatively well investigated. However, very little is known about these obstetric patients' health-related quality of life (HRQoL) before and after critical care. The objective of this study was to assess obstetric patients' HRQoL before intensive care admission (baseline) and at 6 months after discharge (follow-up) DESIGN: This was a retrospective database study. In a 5-year period, the data of all women admitted to the intensive care unit (ICU) during pregnancy, delivery, or up to 42 days postpartum were analysed. Four multidisciplinary ICUs of Finnish University hospitals participated. The HRQoL was assessed using the EuroQol-5D (EQ-5D) instrument with utility score (EQsum) and visual analogue scale (EQ-VAS). A total of 283 obstetric patients were identified from the clinical information system. Of these, 99 (35%) completed the EQ-5D questionnaires both at baseline and follow-up, and 65 of them (23%) completed EQ-VAS. The comparison of patients' EQsum scores before intensive care admission and after discharge showed that patients' HRQoL remained good (0.970 vs 0.972) (max 1.0) or increased (0.788 vs 0.982) in 80.8% of the patients. Patients reported improved overall health on the EQ-VAS at 6 months follow-up (EQ-VAS mean, 71.86 vs 88.20; p ≤ 0.001) (max 100). However, 19.2% of the patients had lower HRQoL (EQsum mean 0.987 vs 0.798) at follow-up. Following intensive care, 15% of the patients had more pain/discomfort, and 11% expressed more depression/anxiety. Multiparous patients were more likely to suffer from worsened depression/anxiety (p = 0.024). In the majority of the obstetric patients, HRQoL at 6 months follow-up remained good or had increased from baseline. However, nearly one-fifth of the patients had impaired HRQoL after discharge. Thus, intensive care management should take in to consideration follow-up program after intensive care of ICU-admitted obstetric
Willemse, Bernadette M.; Jonge, de J.; Smit, D.; Visser, Q.; Depla, M.F.I.A.; Pot, Anne Margriet
Aim: To explore the role of nursing staff's person-centredness caring for people with dementia in relation to their work environment and job-related well-being. Background: Given the development towards person-centred care and labour force issues, research has recently focused on the effect of
Kitase, Yuma; Hayakawa, Masahiro; Kondo, Taiki; Saito, Akiko; Tachibana, Takashi; Oshiro, Makoto; Ieda, Kuniko; Kato, Eiko; Kato, Yuichi; Hattori, Tetsuo; Hayashi, Seiji; Ito, Masatoki; Hyodo, Reina; Muramatsu, Yukako; Sato, Yoshiaki
Trisomy 13 (T13) is accompanied by severe complications, and it can be challenging to achieve long-term survival without aggressive treatment. However, recently, some patients with T13 have been receiving home care. We conducted this study to investigate factors related to home health-care transition for patients with T13.We studied 28 patients with T13 born between January 2000 and December 2014. We retrospectively compared nine home care transition patients (the home care group) and 19 patients that died during hospitalization (the discharge at death group). The median gestational age of the patients was 36.6 weeks, with a median birth weight of 2,047 g. Currently, three patients (11%) have survived, and 25 (89%) have died. The home care group exhibited a significantly longer gestational age (38.9 vs. 36.3 weeks, p = 0.039) and significantly larger occipitofrontal circumference Z score (-0.04 vs. -0.09, p = 0.019). Congenital heart defects (CHD) was more frequent in the discharge at death group, with six patients in the home care group and 18 patients in the discharge at death group (67% vs. 95%, p = 0.047), respectively. Survival time was significantly longer in the home care group than in the discharge at death group (171 vs. 19 days, p = 0.012). This study has shown that gestational age, occipitofrontal circumference Z score at birth, and the presence of CHD are helpful prognostic factors for determining treatment strategy in patients with T13. © 2017 Wiley Periodicals, Inc.
Lohmann, Susanne; Mattern, Elke; Ayerle, Gertrud M
To explore how midwives perceive patient preferences related to midwifery care in Germany. This qualitative study, which was part of a larger study, used a hermeneutic-interpretive approach and involved focus group interviews with midwives. Data collection and analysis were done in a conjoined fashion between April 2015 and September 2016. Four focus group interviews were conducted in four different federal states of Germany. The sample of 20 qualified midwives was heterogeneous with regards to age, educational level, professional experience, type of midwifery care provided, and setting (employed, caseload, education) in which they provided services. Three main themes were identified: Strengths and limitations of midwives' present professional profile (midwives' area of responsibility, range of services, and competency); lack of midwives and midwifery services; women's experiences of conflict in interprofessional care. Each main theme is broken down into several aspects of content. Many women are not aware of the scope of professional knowledge and expertise of midwives. Moreover, the poor delineation of midwives' and obstetricians' areas of competency in Germany's hospitals seems to be disadvantageous for the women. Midwives feel that due to context implications they cannot live up to the quality of midwifery care they aspire to. Lack of midwives results in midwives being overwhelmed, women underserved, and both disappointed. On the one hand, new models of midwifery/maternity care need to be developed to solve some of the existing problems; on the other hand, new forms of interprofessional cooperation and management of transition of care points are required. Overall it is important that changes are implemented in such a way that women are enabled, and welcome, to clearly state their preferences for midwifery and maternity care. Particularly in Germany, tertiary education of midwives is needed to broaden their expertise and place them on an equal footing with
Full Text Available Background: Family caregiver is the most important person who cares for patient with schizophrenia. However when care is provided for long time, he/she may experiences the burden.Purpose: The purpose was to review concept and factors related to burden on family caregivers caring for patients with schizophrenia.Method: A literatures were searched from databases: Pubmed, CINAHL, and Science Direct. Key words used to retrieve literature include caregiver burden and schizophrenia. Searching was limited in English language, full text, and the year of publication from 2000 to 2009 was used.Results: Twenty two studies were reviewed in this paper. The result showed that the caregivers caring for patients with schizophrenia experience burden. Burden was defined as a negative impact of caring for the impaired person experienced by caregiver on their activity (objective burden or feeling (subjective burden that involves emotional, physical health, social life, and financial status. Factors related to burden on family caregiver were grouped into: 1 caregiver‟s factors included age, gender, educational level, income, health status, and spent time per day, knowledge of schizophrenia, culture, and coping; 2 patient‟s factors included age, clinical symptoms, and disability in daily life; 3 environmental factors included mental health service and social support.Conclusion: Definition of burden have quite same meaning and mostly factors focus on the patient‟s symptoms, demographic factors of caregiver, and time spent per day. Most of studies cannot be generalized due to small sample used in the study and that too conducted in western countries. For further research, the correlation between burden and resources of family caregiver should be investigated particularly in eastern country.Key words: burden on family caregiver, caring, schizophrenia.
de Graaff, F.M.; Mistiaen, P.; Devillé, W.L.J.M.; Francke, A.L.
Background Our aim was to obtain a clearer picture of the relevant care experiences and care perceptions of incurably ill Turkish and Moroccan patients, their relatives and professional care providers, as well as of communication and decision-making patterns at the end of life. The ultimate
de Graaff, F.M.; Mistiaen, P.; Deville, W.L.; Francke, A.L.
Abstract. Background: Our aim was to obtain a clearer picture of the relevant care experiences and care perceptions of incurably ill Turkish and Moroccan patients, their relatives and professional care providers, as well as of communication and decision-making patterns at the end of life. The
Graaff, F.M. de; Mistiaen, P.; Devillé, W.L.J.M.; Francke, A.L.
Background: Our aim was to obtain a clearer picture of the relevant care experiences and care perceptions of incurably ill Turkish and Moroccan patients, their relatives and professional care providers, as well as of communication and decision-making patterns at the end of life. The ultimate
Eliassen, A Henry
Unequal power relations lie just below the surface in much of today's discourse on health care communication with older adults. Focusing on pathologies or deficits tends to reinforce stereotypes of frailty and dependency, thus framing elders as a vulnerable group requiring special assistance. Implicit stereotyping frequently colors interactions of health care personnel with older clients and their families-interactions likely to affect elders' perceptions and health outcomes. Health care providers need to be attuned to the vast and growing diversity in today's older population, wherein many older adults are exemplars of what it takes to marshal resources and cope with multifaceted challenges. Thus, elders have the potential to teach medical personnel through narratives of resilience as well as tribulation. This potential can be fully realized, however, only in contexts where communication patterns characterized by paternalism, consumerism, and collaboration are mutually recognized and selectively challenged or implemented. Promising interventions to facilitate health care communication in older adulthood might well be directed toward (a) educating both recipients and providers to become more mindful of cues that evoke stereotypical thinking, (b) promoting an institutional culture that normalizes situationally appropriate assertive responses to stereotyping, and (c) formally ratifying older adults' life experience in the training of health care personnel. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Whittamore, Kathy H; Goldberg, Sarah E; Bradshaw, Lucy E; Harwood, Rowan H
To identify patient and caregiver characteristics associated with caregiver dissatisfaction with hospital care of cognitively impaired elderly adults. Secondary analysis of data from a randomized controlled trial. An 1,800-bed general hospital in England providing the only emergency medical services in its area. Cognitively impaired individuals aged 65 and older randomly assigned to a specialist unit or standard geriatric or internal medical wards (N = 600) and related caregivers (N = 488). Patient and caregiver health status was measured at baseline, including delirium, cognitive impairment, behavioral and psychological symptoms, activities of daily living, and caregiver strain. Caregiver satisfaction with quality of care was ascertained after hospital discharge or death. Four hundred sixty-two caregivers completed satisfaction questionnaires. Regardless of assignment, 54% of caregivers were dissatisfied with some aspects of care, but overall 87% were satisfied with care. The main areas of dissatisfaction were communication, discharge planning, and medical management. Dissatisfaction was associated with high levels of patient behavioral and psychological symptoms on admission, caregiver strain and poor psychological well-being at admission, a diagnosis of delirium, and the relationship between the caregiver and the patient. There was less dissatisfaction from caregivers of patients managed on the specialist Medical and Mental Health Unit than those on standard wards, after controlling for multiple factors. Dissatisfaction was associated with patient behavioral and psychological symptoms and caregiver strain but was not immutable to efforts to improve care. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Sandsdalen, Tuva; Høye, Sevald; Rystedt, Ingrid; Grøndahl, Vigdis Abrahamsen; Hov, Reidun; Wilde-Larsson, Bodil
Little is known about the combination of person- and organization- related conditions and the relationships with patients' perspectives of care quality. Such a combination could contribute knowledge reflecting the complexity of clinical practice, and enhance individualized care. The aim was to investigate the relationships between the combination of person- and organization-related conditions and patients' perceptions of palliative care quality. A cross-sectional study, including 191 patients in the late palliative phase (73% response rate) admitted to hospice inpatient care (n = 72), hospice day care (n = 51), palliative units in nursing homes (n = 30) and home care (n = 38), was conducted between November 2013 and December 2014, using the instrument Quality from the Patients' Perspective specific to palliative care (QPP-PC). Data were analysed, using analysis of covariance, to explore the amount of the variance in the dependent variables (QPP-PC) that could be explained by combination of the independent variables - Person- and organization-related conditions, - while controlling for differences in covariates. Patients scored the care received and the subjective importance as moderate to high. The combination of person- and organization - related conditions revealed that patients with a high sense of coherence, lower age (person - related conditions) and being in a ward with access to and availability of physicians (organization-related condition) might be associated with significantly higher scores for the quality of care received. Gender (women), daily contact with family and friends, and low health-related quality of life (person-related conditions) might be associated with higher scores for subjective importance of the aspects of care quality. Healthcare personnel, leaders and policy makers need to pay attention to person- and organization-related conditions in order to provide person-centered palliative care of high quality. Further studies from
Høybye, Mette Terp
Given the growing attention to the importance of design in shaping healing hospital environments this study extends the understanding of healing environments, beyond causal links between environmental exposure and health outcome by elucidating how environments and practices interrelate. The study was conducted as an ethnographic fieldwork from March 2011 to September 2011 at the Department of Haematology at Odense University Hospital, Denmark, systematically using participant observation and interviews as research strategies. It included 20 patients, four of who were followed closely over an extended time period. Through thematic analysis five key concepts emerged about the social dynamics of hospital environments: practices of self; creating personal space; social recognition; negotiating space; and ambiguity of space and care. Through these concepts, the study demonstrates how the hospital environment is a flow of relations between space and practice that changes and challenges a structural idea of design and healing. Patients' sense of healing changes with the experience of progression in treatment and the capacity of the hospital space to incite an experience of homeliness and care. Furthermore, cancer patients continuously challenge the use and limits of space by individual objects and practices of privacy and home. Healing environments are complex relations between practices, space and care, where recognition of the individual patient's needs, values and experiences is key to developing the environment to support the patient quality of life. The present study holds implications for practice to inform design of future hospital environments for cancer treatment. The study points to the importance for being attentive to the need for flexible spaces in hospitals that recognize the dynamics of healing, by providing individualized care, relating to the particular and changing needs of patients supporting their potential and their challenged condition with the best
Vladimir Araujo de Silva
Full Text Available This phenomenological study was structured on Heidegger’s theoretical-philosophical framework, with the objective of unveiling the significances and meanings of the musical identity of patients and relatives under oncological palliative care. Individual interviews were performed with 12 clients (seven patients and five relatives staying at the support residence of the Maringa Female Network Against Cancer. A total of eight musical meetings were performed between January and February of 2011. I understood that the musical identity of the evidenced beings refers to the religious and country music styles, that their significances and meanings are connected to their spirituality and the significant events of their historicity, and that their mood and reflection intermediated by music can influence their musical choice. I gave evidence to the need to consider the music identity and empowerment in musical choices, which carries existential, social, cultural, spiritual and family aspects as qualifying elements of nursing in palliative care. Descriptors: Nursing Care; Oncology Nursing; Music; Music Therapy; Palliative Care.
'From activating towards caring': shifts in care approaches at the end of life of people with intellectual disabilities; a qualitative study of the perspectives of relatives, care-staff and physicians.
Bekkema, N.; Veer, A.J.E. de; Hertogh, C.M.P.M.; Francke, A.L.
Background: Professionals and relatives increasingly have to deal with people with intellectual disabilities (ID) who are in need of end-of-life care. This is a specific type of care that may require a different approach to the focus on participation that currently characterizes the care for people
'From activating towards caring': shifts in care approaches at the end of life of people with intellectual disabilities; a qualitative study of the perspectives of relatives, care-staff and physicians
Bekkema, N.; de Veer, A.J.E.; Hertogh, C.M.P.M.; Francke, A.L.
Background: Professionals and relatives increasingly have to deal with people with intellectual disabilities (ID) who are in need of end-of-life care. This is a specific type of care that may require a different approach to the focus on participation that currently characterizes the care for people
Ericson-Lidman, Eva; Strandberg, Gunilla
Conscience can be perceived as an asset that helps care providers to provide good care, but it can also be a burden that generates stress of conscience (stress related to a troubled conscience). Participatory action research (PAR) has been shown to be successful in supporting care providers in residential care of older people to learn to deal with their troubled conscience in challenging and demanding care situations. The aim of the study was to describe an intervention process to assist care providers in residential care of older people to constructively deal with their troubled conscience related to perceptions of deficient teamwork. The study design was grounded in PAR. Nine enrolled nurses (ENs), two nursing aids (NAs), one Registered Nurse (RN) and their manager participated in 12 PAR sessions. All sessions were tape-recorded, and a domain analysis of the transcriptions was performed. Findings show that a PAR-based intervention can support care providers to understand, handle and take measures against deficient teamwork. Using troubled conscience as a driving force can increase the opportunities to improve quality of care in residential care for older people. During the PAR process, participants raised their awareness of the need to view the team in a wider sense and that the manager and the Registered Nurse should also be members of the team to improve team outcome. To improve clinical practice, we suggest that teams in residential care of older people should be enabled to share and reflect on challenging situations that generate troubled conscience. However, as shown in this study, care providers might need support in order to facilitate and promote sharing and reflecting on what their conscience tells them. © 2014 Nordic College of Caring Science.
Clemmer, Terry P
There are 3 key ingredients in improving quality of medial care: 1) using a scientific process of improvement, 2) executing the process at the lowest possible level in the organization, and 3) measuring the results of any change reliably. Relational databases when used within these guidelines are of great value in these efforts if they contain reliable information that is pertinent to the project and used in a scientific process of quality improvement by a front line team. Unfortunately, the data are frequently unreliable and/or not pertinent to the local process and is used by persons at very high levels in the organization without a scientific process and without reliable measurement of the outcome. Under these circumstances the effectiveness of relational databases in improving care is marginal at best, frequently wasteful and has the potential to be harmful. This article explores examples of these concepts.
Høybye, Mette Terp
of the individual patient ’ s needs, values and experiences is key to developing the environment to support the patient quality of life. The present study holds implications for practice to inform design of future hospital environments for cancer treatment. The study points to the importance for being attentive...... these concepts, the study demonstrates how the hospital environment is a fl ow of relations between space and practice that changes and challenges a structural idea of design and healing. Patients ’ sense of healing changes with the experience of progression in treatment and the capacity of the hospital space...... to incite an experience of homeliness and care. Furthermore, cancer patients continuously challenge the use and limits of space by individual objects and practices of privacy and home. Discussion. Healing environments are complex relations between practices, space and care, where recognition...
'From activating towards caring': shifts in care approaches at the end of life of people with intellectual disabilities; a qualitative study of the perspectives of relatives, care-staff and physicians.
Bekkema, Nienke; de Veer, Anke J E; Hertogh, Cees M P M; Francke, Anneke L
Professionals and relatives increasingly have to deal with people with intellectual disabilities (ID) who are in need of end-of-life care. This is a specific type of care that may require a different approach to the focus on participation that currently characterizes the care for people with ID. This paper describes the shifts in care approaches and attitudes that relatives and professionals perceive as the death of a person with ID approaches, as well as the values underlying these shifts. A qualitative design was used to reconstruct the cases of twelve recently deceased people with ID. Relatives and professionals who were closest to the person at the end of their life were interviewed. Interviews were transcribed verbatim and data were analyzed inductively, using elements of thematic analysis. Five shifts were found: 1) adapting to a new strategy of comforting care, taking over tasks and symptom relief, 2) interweaving of emotional and professional involvement, 3) stronger reliance on the joint interpretation of signals expressing distress and pain, 4) magnified feeling of responsibility in medical decisions, 5) intensified caring relationship between 'two families': relatives and care staff. Six relational values were behind these shifts: 'being there' for the person with ID, 'being responsive' to the person's needs, 'reflection' on their own emotions and caring relationships, 'attentiveness' to the ID person's wishes and expressions of distress, 'responsibility' for taking joint decisions in the best interests of the person, and 'openness to cooperation and sharing' the care with others. End-of-life care for people with ID involves curtailing expectations of participation and skill acquirement, and an increase in teamwork featuring intensified comforting care, symptom management and medical decision making. Three caring relationships need to be fostered: the relationship with the person with ID, relationships among professionals and the relationship between
Davison, Sara N; Levin, Adeera; Moss, Alvin H; Jha, Vivekanand; Brown, Edwina A; Brennan, Frank; Murtagh, Fliss E M; Naicker, Saraladevi; Germain, Michael J; O'Donoghue, Donal J; Morton, Rachael L; Obrador, Gregorio T
Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic and assessment tools are limited, and quality of care, particularly regarding conservative and palliative care, is suboptimal. The KDIGO Controversies Conference on Supportive Care in CKD reviewed the current state of knowledge in order to define a roadmap to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis. An international group of multidisciplinary experts in CKD, palliative care, methodology, economics, and education identified the key issues related to palliative care in this population. The conference led to a working plan to address outstanding issues in this arena, and this executive summary serves as an output to guide future work, including the development of globally applicable guidelines.
Montero García, Antonio; Morales Asencio, José Miguel; Trujillo Illescas, Juan Alfonso; Martí, Celia
To explore the frequency of lack of autonomous mobility and factors related to it in patients requiring prehospital emergency services. Cross-sectional, observational, retrospective analysis. We identified a stratified random sample of patients attended by the public health emergency service of Andalusia in 2011. The sample included 280 patients with a mean age of 56 years; 63.9% were men. The majority were attended in homes and streets or other public spaces. Most were transported to a hospital in a mobile intensive care unit. The reasons for calling the service were most often related to chest pain or injuries. Loss of autonomous mobility was seen more often in men, when care was required in a public area, when there were injuries or altered vital signs, and when the patient required transport in a mobile intensive care unit. Dependence on others was significantly associated with the presence of a prior condition before the patient required transport (odds ratio [OR], 3.27; 95% CI, 1.60-6.33), the use of immobilization strategies (OR, 7.71; 95% CI, 1.7-34.96], and the use of ambulance transport (OR, 4.35; 95% CI, 1.63-11.60]. The following 2 variables were at the limit of significance: pain during the care process (OR, 1.13; 95% CI, 0.99-1.29) and age (OR, 0.46; 95% CI, 0.97-1.01). The profile we identified for patients and situations in which patients cannot move autonomously during prehospital emergency care can be used to plan preventive strategies to ensure patient safety.
This report estimates the health care burden related to the wars in Iraq and Afghanistan by calculating the difference between the total health care delivered to U.S. military members during wartime (October 2001 to June 2012) and that which would have been delivered if pre-war (January 1998 to August 2001) rates of ambulatory visits, hospitalizations, and hospital bed days of active component members of the U.S. Armed Forces had persisted during the war. Overall, there were estimated excesses of 17,023,491 ambulatory visits, 66,768 hospitalizations, and 634,720 hospital bed days during the war period relative to that expected based on pre-war experience. Army and Marine Corps members and service members older than 30 accounted for the majority of excess medical care during the war period. The illness/injury-specific category of mental disorders was the single largest contributor to the total estimated excesses of ambulatory visits, hospitalizations, and bed days. The total health care burdens associated with the wars in Afghanistan and Iraq are undoubtedly greater than those enumerated in this report because this analysis did not address care delivered in deployment locations or at sea, care rendered by civilian providers to reserve component members in their home communities, care of veterans by the Departments of Defense and Veterans Affairs, preventive care for the sake of force health protection, and future health care associated with wartime injuries and illnesses.
Grøthe, Å; Biong, Stian; Grov, E K
Admission of a cancer patient to a palliative unit when near the final stage of their disease trajectory undoubtedly impacts their relatives. The aim of our study was to illuminate and interpret relatives' lived experiences of health personnel's provision of care in a palliative ward. A phenomenological/hermeneutic approach was employed that was inspired by the philosophical tradition of Heidegger and Ricoeur and further developed by Lindseth and Nordberg. The perspectives of the narrator and the text were interpreted by highlighting relatives' views on a situation in which they have to face existential challenges. The analysis was undertaken in three steps: naïve reading, structural analysis, and comprehensive understanding, including the authors' professional experiences and theoretical background. Six subthemes appeared: the dying person, the bubble, the sight, the cover, the provision for children's needs, and the availability of immediate help. These components were further constructed into three themes: the meaning of relating, the meaning of action, and the meaning of resources. Our comprehensive understanding of the results suggests that the most important theme is "acting with dedication and expertise." The following aspects are crucial for relatives of cancer patients hospitalized in a palliative ward: time and existence, family dynamics, and care adjusted to the situation. Our study results led to reflections on the impact of how nurses behave when providing care to patients during the palliative phase, and how they interact with relatives in this situation. We found that cancer patients in a palliative unit most appreciate nurses who act with dedication and expertise.
Kovavisarach, Ekachai; Phromsila, Raweewan
To determine the risk factors related to heartburn in pregnant women attending the antenatal care clinic, Rajavithi Hospital. Self-reporting questionnaire about demographic data and risk factors related to heartburn in those pregnant women between May 1 and July 31, 2010. Heartburn was found in 55 out of 452 pregnant women (12.2%). There were no significant differences in demographic characteristics and risk factors between the heartburn and non-heartburn groups. Consumption of alcoholic drinks was a reversely significant risk factor of heartburn (OR 0.11, CI 0.01 to 0.78) (p = 0.005). Heartburn was not uncommon, and no associated factors were demonstrated.
Castillo-Mancilla, Jose R; Phillips, Andrew N; Neaton, James D
Suboptimal (ie, <100%) antiretroviral therapy (ART) adherence has been associated with heightened inflammation in cohort studies, even among people with virologic suppression. We aimed to evaluate this association among participants in the Strategies for Management of Antiretroviral Therapy (SMAR...
Lie, Hanne C; Mellblom, Anneli V; Brekke, Mette; Finset, Arnstein; Fosså, Sophie D; Kiserud, Cecilie E; Ruud, Ellen; Loge, Jon H
Given childhood cancer survivors' risk of treatment-induced late effects, long-term follow-up care is recommended. We explored experiences with late effects-related care and preferences for long-term follow-up care among adult survivors of childhood malignant lymphoma in Norway. We conducted five focus group interviews with 34 survivors (19 females; 21 Hodgkin/13 non-Hodgkin lymphoma survivors; mean age 39 years; mean time from diagnosis 26 years). Data was analyzed using principles of thematic analysis. Two main themes were identified: (1) the survivors' experiences with late effects-related care and (2) their preferences for long-term follow-up care. Most of the survivors were dissatisfied with their late effects-related care due to perceptions of poor coordination of healthcare needs in a fragmented system, combined with a perceived lack of knowledge of late effects among themselves and general practitioners (GPs). All survivors valued long-term follow-up care. Oncologists were the preferred care providers, but GPs were considered acceptable providers if they had sufficient knowledge of late effects and routine examinations, short waiting times, and improved GP-oncologist collaboration. Our results suggest that a shared care model of long-term follow-up care involving specialists, GPs, and the survivors themselves is likely to fulfill several of the currently unmet needs among adult survivors of childhood cancers. Improved patient education about late effects and follow-up care would aid self-management. The survivors' concerns regarding lack of sufficient knowledge of late effects among GPs suggest a need for improving access to, and dissemination of, information of late effects.
Rudel, Miriam; Abraham, Martin; Görtler, Edmund
The availability of local support and care infrastructures at the place of residence is an important issue for the elderly living in rural areas. Spatial mobility can be seen as a strategy to cope with a lack of local care facilities. This study analyzes the preferences of older people living in long-term relationships concerning support and care arrangements. Furthermore, it is analyzed how far and under which circumstances older couples are willing to relocate their place of residence in response to regional care infrastructures. Using a quasi-experimental survey design, inhabitants of a small rural community aged over 50 years were interviewed and confronted with descriptions of fictitious situations with randomized options for moving residence. A Tobit model estimation method is applied to examine the determinants of older couples' care-related willingness to move their residence.The results show that most people prefer either the support of their own partner or outpatient care. Residential care is especially preferred by people aged 75 years and above, whereas new forms of support, such as senior cooperatives, are evaluated as attractive especially by younger age groups. Thus, information and advisory campaigns should address the target group in question even at an early stage in older peoples' life course. Care-related willingness to move home of couples aged 50 years and more is significantly determined by local provision of support and care infrastructures. The expansion of any care infrastructure at older peoples' place of residence can significantly reduce their willingness to move. In particular an increased availability of outpatient care is associated with a comparatively large reduction in couples' likelihood to move. In this way local commitment to rural areas can be sustained and rural depopulation can be prevented. At an alternative place of residence assisted living and residential care in particular can significantly enhance the willingness to
Danford, David A; Karels, Quentin; Kulkarni, Aparna; Hussain, Aysha; Xiao, Yunbin; Kutty, Shelby
Quantifying resource utilization in the inpatient care of congenital heart diease is clinically relevant. Our purpose is to measure the investment of inpatient care resources to achieve survival in hypoplastic left heart syndrome (HLHS), and to determine how much of that investment occurs in hospitalizations that have a fatal outcome, the mortality-related resource utilization fraction (MRRUF). A collaborative administrative database, the Pediatric Health Information System (PHIS) containing data for 43 children's hospitals, was queried by primary diagnosis for HLHS admissions of patients ≤21 years old during 2004-2013. Institution, patient age, inpatient deaths, billed charges (BC) and length of stay (LOS) were recorded. In all, 11,122 HLHS admissions were identified which account for total LOS of 277,027 inpatient-days and $3,928,794,660 in BC. There were 1145 inpatient deaths (10.3%). LOS was greater among inpatient deaths than among patients discharged alive (median 17 vs. 12, p providers and consumers that current practices often result in major resource expenditure for inpatient care of HLHS that does not result in survival to hospital dismissal. They highlight the need for data-driven critical review of standard practices to identify patterns of care associated with success, and to modify approaches objectively.
Kristiansson, Charlotte; Gotuzzo, Eduardo; Rodriguez, Hugo
ABSTRACT: BACKGROUND: Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drug...... be indicated. Caregivers frequently paid for health services as well as antibiotics, even though all children in the study qualified for free health care and medicines. The implementation of the Seguro Integral de Salud health insurance must be improved.......ABSTRACT: BACKGROUND: Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drugs...... in Yurimaguas and 793 children of the same age in Moyobamba were included in the study. Caregivers were interviewed on health care seeking strategies (public/private sectors; formal/informal providers), and medication for their children in relation to reported symptoms and socio-economic status. Self...
Plakas, Sotirios; Taket, Ann; Cant, Bob; Fouka, Georgia; Vardaki, Zambia
To explore the meaning of vigilant attendance for relatives of critically ill patients in Greece. A plethora of international research has identified proximity to the patient to be a major concern for relatives of critically ill patients. Greece however follows a strict visiting policy in intensive care units (ICUs) so Greek relatives spend great amounts of time just outside the ICUs. This qualitative study adopted the social constructionist version of grounded theory. Data were collected from three ICUs in Athens through in depth interviews with 25 informants and approximately 10 h of observations outside the ICUs on 159 relatives. Vigilant attendance was one of the main coping mechanisms identified for relatives. Four subcategories were found to comprise vigilant attendance: (1) being as close as possible to feel relief, (2) being there to find out what is going on, (3) monitoring changes in the loved one and making own diagnosis and (4) interacting with the ICU professionals. Vigilant attendance describes the way in which relatives in Greece stayed outside the ICUs. Relatives felt satisfaction from being close as the best alternative for not actually being inside the ICU and they tried to learn what was going on by alternative methods. By seeing the patients, relatives were also able to make their own diagnoses and could therefore avoid relying solely on information given to them. However, a prerequisite for successful vigilant attendance was to get on well with doctors and nurses. Changes in visiting policies in Greece are needed to meet the needs of relatives adequately. Recommendations for changes with minimal investment of time and funding are made. © 2013 British Association of Critical Care Nurses.
Thanh Duong Cong
Full Text Available Abstract Background Seeking and utilisation of HIV prevention, treatment, care, and support services for people living with HIV is often hampered by HIV-related stigma. The study aimed to explore the perceptions and experiences regarding treatment, care, and support amongst people living with HIV in Viet Nam, where the HIV epidemic is concentrated among injecting drug users, sex workers, and men who have sex with men. Methods In-depth interviews and focus group discussions were conducted during September 2007 in 6 districts in Hai Phong with a very high HIV prevalence among injecting drug users. The information obtained was analysed and merged within topic areas. Illustrative quotes were selected. Results Stigma and discrimination against people living with HIV in the community and healthcare settings was commonly reported, and substantially hampered the seeking and the utilisation of HIV-related services. The informants related the high level of stigma to the way the national HIV preventive campaigns played on fear, by employing a “scare tactic” mainly focusing on drug users and sex workers, who were defined as “social evils” in the anti-drug and anti-prostitution policy. There was a strong exclusion effect caused by the stigma, with serious implications, such as loss of job opportunities and isolation. The support and care provided by family members was experienced as vital for the spirit and hope for the future among people living with HIV. Conclusions A comprehensive care and support programme is needed. The very high levels of stigma experienced seem largely to have been created by an HIV preventive scare tactic closely linked to the “social evil“ approach in the national policy on drug and prostitution. In order to reduce the stigma and create more effective interventions, this tactic will have to be replaced with approaches that create better legal and policy environments for drug users and sex workers.
Zafar, Ammar; Alouini, Mohamed-Slim; Shaqfeh, Mohammad
This work proposes a suboptimal multi-user scheduling scheme for Gaussian broadcast channels which improves upon the classical single user selection, while considerably reducing complexity as compared to the optimal superposition coding with successful interference cancellation. The proposed scheme combines the two users with the maximum weighted instantaneous rate using superposition coding. The instantaneous rate and power allocation are derived in closed-form, while the long term rate of each user is derived in integral form for all channel distributions. Numerical results are then provided to characterize the prospected gains of the proposed scheme.
This work proposes a suboptimal multi-user scheduling scheme for Gaussian broadcast channels which improves upon the classical single user selection, while considerably reducing complexity as compared to the optimal superposition coding with successful interference cancellation. The proposed scheme combines the two users with the maximum weighted instantaneous rate using superposition coding. The instantaneous rate and power allocation are derived in closed-form, while the long term rate of each user is derived in integral form for all channel distributions. Numerical results are then provided to characterize the prospected gains of the proposed scheme.
Andersen, A G; Jensen, T K; Carlsen, E
for military service, this provided a unique opportunity to study the reproductive function in an unbiased population. Altogether 891 young men delivered a blood sample in which reproductive hormones were measured. From 708 of these men data were also obtained on semen quality and testis size. The median sperm...... immotile spermatozoa and follicle stimulating hormone. Possible causes for this high frequency of young men with suboptimal semen quality are obscure and need to be explored. Whether these findings apply for young male populations of comparable countries remains to be seen....
Velloso, Isabela; Ceci, Christine; Alves, Marilia
In this paper, we make explicit the changing configurations of power relations that currently characterize the Brazilian Emergency Care System (SAMU) team in Belo Horizonte, Brazil. The SAMU is a recent innovation in Brazilian healthcare service delivery. A qualitative case study methodology was used to explore SAMU's current organizational arrangements, specifically the power relations that have developed and that demonstrate internal team struggles over space and defense of particular occupational interests. The argument advanced in this paper is that these professionals are developing their work in conditions of exposure, that is, they are always being observed by someone, and that such observational exposure provides the conditions whereby everyday emergency care practices are enacted such that practice is shaped by, as well as shapes, particular, yet recognizable power relationships. Data were collected through the observation of the SAMU's work processes and through semi-structured interviews. Research materials were analyzed using discourse analysis. In the emergency care process of work, visibility is actually embedded in the disciplinary context and can thus be analyzed as a technique applied to produce disciplined individuals through the simple mechanisms elaborated by Foucault such as hierarchical surveillance, normalizing judgment, and the examination. © 2012 John Wiley & Sons Ltd.
Lee, Anne CC; Lawn, Joy E.; Cousens, Simon; Kumar, Vishwajeet; Osrin, David; Bhutta, Zulfiqar A.; Wall, Steven N.; Nandakumar, Allyala K.; Syed, Uzma; Darmstadt, Gary L.
Background Delays in receiving effective care during labor and at birth may be fatal for the mother and fetus, contributing to 2 million annual intrapartum stillbirths and intrapartum-related neonatal deaths each year. Objective We present a systematic review of strategies to link families and facilities, including community mobilization, financial incentives, emergency referral and transport systems, prenatal risk screening, and maternity waiting homes. Results There is moderate quality evidence that community mobilization with high levels of community engagement can increase institutional births and significantly reduce perinatal and early neonatal mortality. Meta-analysis showed a doubling of skilled birth attendance and a 35% reduction in early neonatal mortality. However, no data are available on intrapartum-specific outcomes. Evidence is limited, but promising, that financial incentive schemes and community referral/transport systems may increase rates of skilled birth attendance and emergency obstetric care utilization; however, impact on mortality is unknown. Current evidence for maternity waiting homes and risk screening is low quality. Conclusions Empowering communities is an important strategy to reduce the large burden of intrapartum complications. Innovations are needed to bring the poor closer to obstetric care, such as financial incentives and cell phone technology. New questions need to be asked of “old” strategies such as risk screening and maternity waiting homes. The effect of all of these strategies on maternal and perinatal mortality, particularly intrapartum-related outcomes, requires further evaluation. PMID:19815201
Guerreiro, Mara Pereira; Cantrill, Judith A; Martins, Ana Paula
Preventable drug-related morbidity (PDRM) indicators are operational measures of therapeutic risk management. These clinical indicators, which cover a wide range of drugs, combine process and outcome in the same instrument. They were developed in the US and have been validated for primary care settings in the US, UK and Canada. This study is part of a research programme; it aimed to determine a valid set of PDRM indicators for adult patients in primary care in Portugal. Face validity of 61 US and UK-derived indicators translated to Portuguese was preliminarily determined by means of a postal questionnaire using a purposive sample of four Portuguese pharmacists with different backgrounds. Preliminary content validity of indicators approved in the previous stage was determined by cross-checking each definition of PDRM with standard drug information sources in Portugal. Face and content validity of indicators yielded by preliminary work were then established by a 37 expert panel (20 community pharmacists and 17 general practitioners) using a two-round Delphi survey. Data were analysed using SPSS release 11.5. Nineteen indicators were ruled out in preliminary validation. Changes were made in the content of eight of the remaining 42 indicators; these were related to differences in the drugs being marketed and patterns of drug monitoring between countries. Thirty-five indicators were consensus approved as PDRM for adult patients in Portuguese primary care by the Delphi panel.
Haikonen, Kari; Lillsunde, Pirjo M; Lunetta, Philippe; Lounamaa, Anne; Vuola, Jyrki
The aim of this study was to examine fire-related injuries leading to inpatient care in Finland. The Finnish National Hospital Discharge Register (2000-2009) and a sample of 222 patients from the Helsinki Burn Centre who sustained flame burns was used. During the 10-years study period, the incidence of fire-related injuries with inpatient care was approximately 5.6 per 100000 persons-years (n=295; males 74%, females 26%). Approximately three quarters involved burns and the remaining cases were mostly combustion gas poisonings. Burns declined from 5.4 in 2000 to 4.0 per 100000 person-years in 2009. The decline was accounted for by young people primarily. Socio-economic features and smoking habits differ between the injured and general population. House fire victims were mainly middle aged and older, while injures involving flammable substances, campfires, etc., were mostly associated with young people. House fires caused the worst damage in terms of Total Body Surface Area burned and inhalation burns. Significantly more people die on the scene of the incident than during the hospital care. Targeting preventive measures in particular at older people and those with a tendency for alcohol abuse and smoking could potentially reduce the burden of the most severe flame burns. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.
Scott, Daniel J; Lee, Joon; Silva, Ikaro; Park, Shinhyuk; Moody, George B; Celi, Leo A; Mark, Roger G
The Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database is a free, public resource for intensive care research. The database was officially released in 2006, and has attracted a growing number of researchers in academia and industry. We present the two major software tools that facilitate accessing the relational database: the web-based QueryBuilder and a downloadable virtual machine (VM) image. QueryBuilder and the MIMIC-II VM have been developed successfully and are freely available to MIMIC-II users. Simple example SQL queries and the resulting data are presented. Clinical studies pertaining to acute kidney injury and prediction of fluid requirements in the intensive care unit are shown as typical examples of research performed with MIMIC-II. In addition, MIMIC-II has also provided data for annual PhysioNet/Computing in Cardiology Challenges, including the 2012 Challenge "Predicting mortality of ICU Patients". QueryBuilder is a web-based tool that provides easy access to MIMIC-II. For more computationally intensive queries, one can locally install a complete copy of MIMIC-II in a VM. Both publicly available tools provide the MIMIC-II research community with convenient querying interfaces and complement the value of the MIMIC-II relational database.
Christensen, Martin; Probst, Barbara
The aim of this reflective account is to provide a view of the intensive care unit (ICU) relative's experiences of supporting and being supported in the ICU. Understanding the relatives' experiences of ICU is important especially because a recent work has identified the potential for this group to develop post-traumatic stress disorder, a condition that is normally equated with the ICU survivor. A thematic analysis was used in identifying emerging themes that would be significant in an ICU nursing context. The incident took place in two 8-bedded ICUs (Private and National Health Service) in October. Two emergent themes were identified from the reflective story - fear of the technological environment and feeling hopeless and helpless. The use of relative stories as an insight into the live experiences of ICU relatives may give a deeper understanding of their life-world. The loneliness, anguish and pain of the ICU relative extends beyond the walls of the ICU, and this is often negated as the focus of the ICU team is the patient. Developing strategies to support relatives might include the use of relative diaries used concurrently with patient diaries to support this groups recovery or at the very least a gaining a sense of understanding for their ICU experience. Relative follow-up clinics designed specifically to meet their needs where support and advice can be given by the ICU team, in addition to making timely and appropriate referrals to counselling services and perhaps involving spiritual leaders where appropriate. © 2014 British Association of Critical Care Nurses.
Sellevold, Gerd Sylvi; Egede-Nissen, Veslemøy; Jakobsen, Rita; Sørlie, Venke
Many nursing homes appear as multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Furthermore, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves. The aim of this study is to illuminate multi-ethnic healthcare providers' lived experiences of their own working relationship, and its importance to quality care for people with dementia. The study is part of a greater participatory action research project: 'Hospice values in the care for persons with dementia'. The data material consists of extensive notes from seminars, project meetings and dialogue-based teaching. The text material was subjected to phenomenological-hermeneutical interpretation. Participants and research context: Participants in the project were healthcare providers working in a nursing home unit. The participants came from 15 different countries, had different formal qualifications, varied backgrounds and ethnic origins. Ethical considerations: The study is approved by the Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services. The results show that good working relationships, characterized by understanding each other's vulnerability and willingness to learn from each other through shared experiences, are prerequisites for quality care. The healthcare providers further described ethical challenges as uncertainty and different understandings. The results are discussed in the light of Lögstrup's relational philosophy of ethics and the concepts of vulnerability, ethic responsibility, trust and openness of speech. The prerequisite for quality care for persons with dementia in a multicultural working environment is to create arenas for open discussions between the healthcare providers. Leadership is of great importance.
Stolee, Paul; Hillier, Loretta M; Cook, Sheila; Rockwood, Kenneth
Part of Ontario's strategy on Alzheimer's disease and related dementias (ADRD) was to develop research priorities and recommend strategies for building research capacity. The process to achieve these objectives included an environmental scan, key informant interviews, surveys, and a consensus workshop; this process involved over 100 researchers, clinicians, persons with early dementia, and family caregivers. This article describes the process undertaken, key issues identified, and recommendations for research priorities and for building research capacity; and provides a strategic direction for dementia research in Ontario that is relevant for other jurisdictions. ADRD research in all aspects is required to advance knowledge of ADRD cause, care, and cure; gaps currently exist in understanding effective approaches to care and knowledge transfer. Capacity for high-calibre research hinges on maintaining attractive career paths for researchers, solid infrastructures, and strong partnerships. For research to inform policy and practice, better mechanisms are needed for knowledge exchange.
Full Text Available "Co-production" is becoming an increasingly popular term in policymaking, governance, and research. While the shift from engagement and involvement to co-production in health care holds the promise of revolutionising health services and research, it is not always evident what counts as co-production: what is being produced, under what circumstances, and with what implications for participants. We discuss these questions and propose that co-production can be understood as an exploratory space and a generative process that leads to different, and sometimes unexpected, forms of knowledge, values, and social relations. By opening up this discussion, we hope to stimulate future debates on co-production as well as draw out ways of thinking differently about collaboration and participation in health care and research. Part of the title of this article is inspired by the book "The Social Construction of What?" by Ian Hacking (Cambridge, MA: Harvard University Press; 2000.
Chang, Sherilyn; Zhang, Yunjue; Jeyagurunathan, Anitha; Lau, Ying Wen; Sagayadevan, Vathsala; Chong, Siow Ann; Subramaniam, Mythily
The responsibility of caring for relatives with mental illness often falls on the family members. It has been reported that the reactions to or consequences of providing care are what rendered the role of a caregiver challenging and hence a source of distress. This present study thus aimed to identify socio-demographic correlates of caregiving experiences using the Caregiver Reaction Assessment (CRA) and to examine the associations between reactions to caregiving and psychological distress. A total of 350 caregivers with relatives seeking outpatient care at a tertiary psychiatric hospital were recruited for this study. Distress among caregivers was assessed using the Patient Health Questionnaire (PHQ-9). The CRA was administered to measure reactions from caregiving in four domains including impact on schedule and health (ISH), impact on finance (IF), lack of family support (LFS) and caregiver esteem (CE). Participants also completed a questionnaire that asked for their socio-demographic information. Multivariable linear regression analysis was first used with domains of CRA as outcome variables and socio-demographic variables as predictors in the models. The next set of multivariable linear regression analysis tested for the association between CRA domains and distress with CRA domain scores as outcome variables and PHQ-9 score as predictor, controlling for socio-demographic variables. Socio-demographic correlates of CRA domains identified were age, education, employment, income and ethnicity. Domain scores of CRA were significantly associated with PHQ-9 score even after controlling for socio-demographic variables. A higher distress score was associated with greater impact felt in the domain of ISH (β = 0.080, P social care support in these domains may help to address caregiver distress.
Bjerre-Christensen, Ulla; Kragelund Nielsen, Karoline; Calopietro, Michael
Background: Malaysia seeks to transform its public health sector to manage the growing number of people with diabetes. Patient engagement is a critical clinical competency for HCPs treating people with diabetes. We investigated perceptions of and ability to practice patient engagement among doctors....... The interviews were analysed using qualitative content analysis. Summary of Results: Three main themes emerged: 1) limitations in understanding barriers to self-care and treatment especially from a psychosocial perspective, 2) substantial variation in health care providers’ skills within patient engagement...... health care providers’ ability to place the patient at the center of all therapeutic decisions. Take-home Message: Future efforts to improve self-care should seek to develop competencies within patient engagement especially strengthening understanding of psychosocial barriers to self-care. Organisation...
Yu, Jonas C. P.; Wee, H. M.; Yang, P. C.; Wu, Simon
One of the supply chain risks for hi-tech products is the result of rapid technological innovation; it results in a significant decline in the selling price and demand after the initial launch period. Hi-tech products include computers and communication consumer's products. From a practical standpoint, a more realistic replenishment policy is needed to consider the impact of risks; especially when some portions of shortages are lost. In this paper, suboptimal and optimal order policies with partial backordering are developed for a buyer when the component cost, the selling price, and the demand rate decline at a continuous rate. Two mathematical models are derived and discussed: one model has the suboptimal solution with the fixed replenishment interval and a simpler computational process; the other one has the optimal solution with the varying replenishment interval and a more complicated computational process. The second model results in more profit. Numerical examples are provided to illustrate the two replenishment models. Sensitivity analysis is carried out to investigate the relationship between the parameters and the net profit.
Fernando, Dinusha K; McIntosh, Anne M; Bladin, Peter F; Wilson, Sarah J
Few studies have investigated the patient experience of unsuccessful medical interventions, particularly in the epilepsy surgery field. The present review aimed to gain insight into the patient experience of seizure recurrence after epilepsy surgery by examining the broader literature dealing with suboptimal results after medical interventions (including epilepsy surgery). To capture the patient experience, the literature search focused on qualitative research of patients who had undergone medically unsuccessful interventions, published in English in scholarly journals. Twenty-two studies were found of patients experiencing a range of suboptimal outcomes, including seizure recurrence, cancer recurrence and progression, unsuccessful joint replacement, unsuccessful infertility treatment, organ transplant rejection, coronary bypass graft surgery, and unsuccessful weight-loss surgery. In order of frequency, the most common patient experiences included the following: altered social dynamics and stigma, unmet expectations, negative emotions, use of coping strategies, hope and optimism, perceived failure of the treating team, psychiatric symptoms, and control issues. There is support in the epilepsy surgery literature that unmet expectations and psychiatric symptoms are key issues for patients with seizure recurrence, while other common patient experiences have been implied but not systematically examined. Several epilepsy surgery specific factors influence patient perceptions of seizure recurrence, including the nature of postoperative seizures, the presence of postoperative complications, and the need for increased postoperative medications. Knowledge of common patient experiences can assist in the delivery of patient follow-up and rehabilitation services tailored to differing outcomes after epilepsy surgery. Copyright © 2014 Elsevier Inc. All rights reserved.
Full Text Available The aim of this study was to determine the effect of different seed treatments on germination parameters of three maize genotypes under optimal and suboptimal temperature conditions. Seed was treated with recommended doses of three commercial pesticide formulations: metalaxyl-m 10 g/L + fludioxonil 25 g/L, metalaxyl 20 g/kg + prothioconazole 100 g/kg and thiacloprid 400 g/L. Testing was conducted at 25°C and 15°C. Results of the study indicate that there are differences in response of maize genotypes to applied seed treatments, as well as to a specific treatment at optimal and suboptimal temperatures. Some treatments, depending on the mixing partner and temperature conditions, can affect final germination. In other cases, germination rate can be accelerated or prolonged, but with no effect on final germination. In order to provide fast and uniform emergence under different temperature conditions, further examination of the response of maize genotypes to specific seed treatments would be beneficial.
Ratnayake R.M. Chandima
Full Text Available Manufacturing firms continuously strive to increase the efficiency and effectiveness in the maintenance management processes. Focus is placed on eliminating the unexpected failures which cause unnecessary costs and the production losses. Risk-based maintenance (RBM strategies enable to address the above through the identification of probability and consequences of potential failures whilst providing a way for prioritisation of maintenance actions based on the risk of possible failures. Such prioritisations enable to identify the optimal maintenance strategy, intervals of maintenance tasks, and optimal level of spare parts inventory. However, the risk assessment activities are performed with the support of a risk matrix. Suboptimal classifications and/or prioritisations arise due to the inherent nature of the risk matrix. This is caused by the fact that there are no means to incorporate actual circumstances at the boundary of the input ranges or at the levels of linguistic data and risk categories. In this paper, a risk matrix is first developed in collaboration with one of the manufacturing firms in Poland. Then, it illustrates the use of fuzzy logic for minimisation of suboptimal prioritisation and/or classifications using a fuzzy inference system (FIS together with illustrative membership functions and a rule base. Finally, an illustrative risk assessment is also demonstrated to illustrate the methodology.
We propose a framework for multiagent systems in which the agents compute their control actions in real time, based on local information only. The novelty of the proposed framework is that the process of computing a suboptimal control action is divided into two phases: an offline phase and an online phase. In the offline phase, an approximate problem is formulated with a cost function that is close to the optimal cost in some sense and is distributed, i.e., the costs of non-neighboring nodes are not coupled. This phase is centralized and is completed before the deployment of the system. In the online phase, the approximate problem is solved in real time by implementing any efficient distributed optimization algorithm. To quantify the performance loss, we derive upper bounds for the maximum error between the optimal performance and the performance under the proposed framework. Finally, the proposed framework is applied to an example setup in which a team of mobile nodes is assigned the task of establishing a communication link between two base stations with minimum energy consumption. We show through simulations that the performance under the proposed framework is close to the optimal performance and the suboptimal policy can be efficiently implemented online.
Mori, Satomi; Takeda, Juliana Rumy Tsuchihashi; Carrara, Fernanda Souza Angotti; Cohrs, Cibelli Rizzo; Zanei, Suely Sueko Viski; Whitaker, Iveth Yamaguchi
To identify the incidence of delirium, compare the demographic and clinical characteristics of patients with and without delirium, and verify factors related to delirium in critical care patients. Prospective cohort with a sample made up of patients hospitalized in the Intensive Care Unit (ICU) of a university hospital. Demographic, clinical variables and evaluation with the Confusion Assessment Method for Intensive Care Unit to identify delirium were processed to the univariate analysis and logistic regression to identify factors related to the occurrence of delirium. Of the total 149 patients in the sample, 69 (46.3%) presented delirium during ICU stay, whose mean age, severity of illness and length of ICU stay were statistically higher. The factors related to delirium were: age, midazolam, morphine and propofol. Results showed high incidence of ICU delirium associated with older age, use of sedatives and analgesics, emphasizing the need for relevant nursing care to prevent and identify early, patients presenting these characteristics. Identificar a incidência de delirium, comparar as características demográficas e clínicas dos pacientes com e sem delirium e verificar os fatores relacionados ao delirium em pacientes internados em Unidade de Terapia Intensiva (UTI). Coorte prospectiva, cuja amostra foi constituída de pacientes internados em UTI de um hospital universitário. Variáveis demográficas, clínicas e da avaliação com o Confusion Assessment Method for Intensive Care Unit para identificação de delirium foram processadas para análise univariada, e regressão logística para identificar fatores relacionados à ocorrência do delirium. Do total de 149 pacientes da amostra, 69 (46,3%) apresentaram delirium durante a internação na UTI, observando-se que a média da idade, o índice de gravidade e o tempo de permanência nas UTI foram estatisticamente maiores. Os fatores relacionados ao delirium foram: idade, midazolam, morfina e propofol. Os
de Graaff, Fuusje M; Mistiaen, Patriek; Devillé, Walter Ljm; Francke, Anneke L
Our aim was to obtain a clearer picture of the relevant care experiences and care perceptions of incurably ill Turkish and Moroccan patients, their relatives and professional care providers, as well as of communication and decision-making patterns at the end of life. The ultimate objective is to improve palliative care for Turkish and Moroccan immigrants in the Netherlands, by taking account of socio-cultural factors in the guidelines for palliative care. A systematic literature review was undertaken. The data sources were seventeen national and international literature databases, four Dutch journals dedicated to palliative care and 37 websites of relevant national and international organizations. All the references found were checked to see whether they met the structured inclusion criteria. Inclusion was limited to publications dealing with primary empirical research on the relationship between socio-cultural factors and the health or care situation of Turkish or Moroccan patients with an oncological or incurable disease. The selection was made by first reading the titles and abstracts and subsequently the full texts. The process of deciding which studies to include was carried out by two reviewers independently. A generic appraisal instrument was applied to assess the methodological quality. Fifty-seven studies were found that reported findings for the countries of origin (mainly Turkey) and the immigrant host countries (mainly the Netherlands). The central themes were experiences and perceptions of family care, professional care, end-of-life care and communication. Family care is considered a duty, even when such care becomes a severe burden for the main female family caregiver in particular. Professional hospital care is preferred by many of the patients and relatives because they are looking for a cure and security. End-of-life care is strongly influenced by the continuing hope for recovery. Relatives are often quite influential in end-of-life decisions, such
de Graaff Fuusje M
Full Text Available Abstract Background Our aim was to obtain a clearer picture of the relevant care experiences and care perceptions of incurably ill Turkish and Moroccan patients, their relatives and professional care providers, as well as of communication and decision-making patterns at the end of life. The ultimate objective is to improve palliative care for Turkish and Moroccan immigrants in the Netherlands, by taking account of socio-cultural factors in the guidelines for palliative care. Methods A systematic literature review was undertaken. The data sources were seventeen national and international literature databases, four Dutch journals dedicated to palliative care and 37 websites of relevant national and international organizations. All the references found were checked to see whether they met the structured inclusion criteria. Inclusion was limited to publications dealing with primary empirical research on the relationship between socio-cultural factors and the health or care situation of Turkish or Moroccan patients with an oncological or incurable disease. The selection was made by first reading the titles and abstracts and subsequently the full texts. The process of deciding which studies to include was carried out by two reviewers independently. A generic appraisal instrument was applied to assess the methodological quality. Results Fifty-seven studies were found that reported findings for the countries of origin (mainly Turkey and the immigrant host countries (mainly the Netherlands. The central themes were experiences and perceptions of family care, professional care, end-of-life care and communication. Family care is considered a duty, even when such care becomes a severe burden for the main female family caregiver in particular. Professional hospital care is preferred by many of the patients and relatives because they are looking for a cure and security. End-of-life care is strongly influenced by the continuing hope for recovery. Relatives are
Full Text Available Suboptimal temperature stress often causes heavy yield losses of vegetables by suppressing plant growth during winter and early spring. Gibberellin acid (GA has been reported to be involved in plant growth and acquisition of mineral nutrients. However, no studies have evaluated the role of GA in the regulation of growth and nutrient acquisition by vegetables under conditions of suboptimal temperatures in greenhouse. Here, we investigated the roles of GA in the regulation of growth and nitrate acquisition of cucumber (Cucumis sativus L. plants under conditions of short-term suboptimal root-zone temperatures (Tr. Exposure of cucumber seedlings to a Tr of 16°C led to a significant reduction in root growth, and this inhibitory effect was reversed by exogenous application of GA. Expression patterns of several genes encoding key enzymes in GA metabolism were altered by suboptimal Tr treatment, and endogenous GA concentrations in cucumber roots were significantly reduced by exposure of cucumber plants to 16°C Tr, suggesting that inhibition of root growth by suboptimal Tr may result from disruption of endogenous GA homeostasis. To further explore the mechanism underlying the GA-dependent cucumber growth under suboptimal Tr, we studied the effect of suboptimal Tr and GA on nitrate uptake, and found that exposure of cucumber seedlings to 16°C Tr led to a significant reduction in nitrate uptake rate, and exogenous application GA can alleviate the down-regulation by up regulating the expression of genes associated with nitrate uptake. Finally, we demonstrated that N accumulation in cucumber seedlings under suboptimal Tr conditions was improved by exogenous application of GA due probably to both enhanced root growth and nitrate absorption activity. These results indicate that a reduction in endogenous GA concentrations in roots due to down-regulation of GA biosynthesis at transcriptional level may be a key event to underpin the suboptimal Tr
Grigorovich, Alisa; Kontos, Pia
Sexuality and intimacy are universal needs that transcend age, cognitive decline, and disability; sexuality is a fundamental aspect of the human experience. However, supporting sexuality in long-term residential care presents ethical challenges as this setting is both a home environment for residents and a workplace for health practitioners. This is particularly complex in the case of residents with dementia given the need to balance protection from harm and freedom of self-determination. Despite such complexity, this challenge has received limited critical theoretical attention. The dominant approach advocated to guide ethical reasoning is the bioethical four principles approach. However, the application of this approach in the context of dementia and long-term care may set the bar for practitioners' interference excessively high, restricting assentual (i.e., voluntary) sexual expression. Furthermore, it privileges cognitive and impartial decision-making, while disregarding performative, embodied, and relational aspects of ethical reasoning. With an interest in addressing these limitations, we explicate an alternative ethic of embodied relational sexuality that is grounded in a model of citizenship that recognizes relationality and the agential status of embodied self-expression. This alternative ethic broadens ethical reasoning from the exclusive duty to protect individuals from harm associated with sexual expression, to the duty to also uphold and support their rights to experience the benefits of sexual expression (e.g., pleasure, intimacy). As such it has the potential to inform the development of policies, organizational guidelines, and professional curricula to support the sexuality of persons with dementia, and thereby ensure more humane practices in long-term residential care settings.
Helland, Ylva; Dagfinrud, Hanne; Haugen, Mona-Iren; Kjeken, Ingvild; Zangi, Heidi
Men and women with rheumatic diseases report a significantly negative impact on multiple areas of life, including sexuality. Research indicates that patients want to discuss sexual issues with health professionals (HPs) in rheumatology care but these issues are rarely addressed in consultations. The objective of the present study was to explore patients' experiences of communication with HPs about disease-related sexual issues, their perceptions of the relevance of these issues in rheumatology care and their preferences for how these topics should be handled. A qualitative design was used and 18 semi-structured interviews were performed, including eight women and ten men with inflammatory rheumatic joint diseases, aged 29-62 years. The interviews were recorded and transcribed verbatim. Data were analysed thematically. Four main themes were derived from the interviews: (i) relevance of sexual issues; (ii) vital conditions for communication; (iii) individual preferences in mode and timing of information and communication; and (iv) benefits of information and communication. The participants expressed that, although sexual issues are relevant, necessary conditions for good communication are largely lacking. HPs' knowledge, experience and personal skills, as well as having sufficient time were essential. HPs lack of initiating sexual topics contributed to uncertainty about whether their sexual challenges were disease related and whether it was a legitimate topic to discuss in rheumatology care. Patients wanted HPs to possess knowledge about possible disease-related challenges in sexual life and intimate relationships, and to facilitate communication about these aspects. There is a need to develop practice guidelines to enable HPs to integrate sexual issues as an aspect of healthcare delivery in a patient-friendly manner. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Bobko, Natalia A; Barishpolets, Alexey T
A sample of 250 health care workers aged 18 to 68 (mean = 32.5 years) completed the Survey of Health Care Professionals. Self-ratings of their social skills, mental capacity, and physical capability corresponded to their ratings of work demands. Physical tiredness and tension were rated higher than mental tiredness. Worker age did not affect self-ratings of work performance, but physical and mental tiredness increased with increases in the age that one felt. The younger participants felt compared to their calendar ages, the better the level of current work ability they reported. The main concerns of workers were connected with off-the-job factors, most likely caused by the economic crisis and unfavorable ecological conditions in Ukraine. More than half of the participants were quite a bit or extremely concerned with changes in the cost of living, water quality, food safety, and radiation. The variable most closely related to these concerns is the discrepancy between calendar age and how old one feels. Coping strategies of workers can be related to sleeping, entertainment, and other off-the-job activities. These behaviors are related to the discrepancy between calendar age and how old one looks and feels, as well as felt age.
Tavakol Olofsson, Parvin; Aspelin, Peter; Bergstrand, Lott; Blomqvist, Lennart
Outsourcing radiological examinations from public university hospitals affects the patient, who has to attend a different clinic or hospital for the radiological examination. We currently have a limited understanding of how patients view outsourcing and their care related to MR examinations. To examine the experiences of patients who are sent to private radiology units when their referrals for MR examinations are outsourced from a university hospital, as well as to explore factors which influence patient satisfaction regarding the quality of care related to the MR examination. A group of patients (n = 160) referred for MR examinations and either examined at a university hospital or at an external private unit were interviewed. The interview was designed as a verbal questionnaire. Data were analyzed using Student's t test, analysis of variance (ANOVA), and Pearson's correlation. Sixty-nine percent of the patients could neither choose nor influence the location at which they were examined. For those who could, aspects that influenced the patient's choice of radiology department were: short waiting time 79% (127/160), ease of traveling to the radiology department 68% (110/160), and short distance to their home or work 58% (93/160). For 40% (60/160) of the patients, a short time in the waiting room was related to a positive experience of the MR examination. If patients were informed about outsourcing and could also choose where to have their examination, key factors contributing to patient satisfaction could be met even when MR examinations are outsourced.
Spitaels, D.; Vankrunkelsven, P.; Desfosses, J.; Luyten, F.; Verschueren, S.; Assche, D. Van; Aertgeerts, B.; Hermens, R.P.
RATIONALE, AIMS AND OBJECTIVES: Guidelines for patients with knee osteoarthritis (OA) are suboptimally implemented in clinical care. To improve guideline adherence, patients' perceived barriers and facilitators in current care were investigated. METHODS: Eleven patients with knee OA were extensively
Wilhelm Rehnsfeldt, Arne; Lindwall, Lillemor; Høy, Bente
culture is assumed to be a more ontological or universal concept than, for example, an ethical context or ethical person-to-person acts. Research design: The methodological approach is hermeneutic. The data consist of 28 interviews with relatives of older persons from Norway, Denmark and Sweden. Ethical...... considerations: The principles of voluntariness, confidentiality and anonymity were respected during the whole research process. Findings: Three patterns were revealed: dignity as at-home-ness, dignity as the little extra and non-dignifying ethical context. Discussion: Caring communion, invitation, at...
Petersen, John Asger; Rasmussen, Lars S; Rydahl Hansen, Susan
to patients with an elevated EWS, and 3) call for the medical emergency team. METHODS: Focus groups were conducted with nurses from medical and surgical acute care wards, and content analysis was used to identify barriers and facilitating factors in relation to the research questions. RESULTS: Adherence...... was problematic, since many nurses found the team to have negative attitudes. CONCLUSION: EWS reduces complex clinical conditions to a single number, with the inherent risk to overlook clinical cues and subtle changes in patients' condition. The study showed that identifying and treating deteriorating patients...
Minassian, D C; Owens, D R; Reidy, A
To address the absence from the public health ophthalmology literature of age- and sex-specific prevalence and related resource use for diabetic macular oedema (DMO) in England, UK. Calculation of age- and sex-specific rates from primary source clinical data, and application to the demographic structure of England to estimate the number of cases affected by DMO. A public health commissioner and provider of social care perspective was adopted in a standard cost of illness study. The number of people with diabetes in England in 2010 was estimated at 2,342,951 of which 2,334,550 were aged ≥ 12 years. An estimated 166,325 (7.12%) had DMO in one or both eyes, and of these, 64,725 individuals had clinically significant DMO reducing the visual acuity to poorer than 6/6 in at least one eye. The overall health and social care costs in 2010, on the pathway from screening to rehabilitation and care in the home, are estimated at £116,296,038. The outcomes of this study should alert public health commissioners and clinical providers to the burden of DMO. The methods employed should also encourage the use of clinical ophthalmic data at the interface between local population and hospital-based recording systems.
Singh, Kavita; Brodish, Paul; Chowdhury, Mahbub Elahi; Biswas, Taposh Kumar; Kim, Eunsoo Timothy; Godwin, Christine; Moran, Allisyn
Bangladesh achieved Millennium Development Goal 4, a two thirds reduction in under-five mortality from 1990 to 2015. However neonatal mortality remains high, and neonatal deaths now account for 62% of under-five deaths in Bangladesh. The objective of this paper is to understand which newborns in Bangladesh are receiving postnatal care (PNC), a set of interventions with the potential to reduce neonatal mortality. Using data from the Bangladesh Maternal Mortality Survey (BMMS) 2010 we conducted logistic regression analysis to understand what socio-economic and health-related factors were associated with early postnatal care (PNC) by day 2 and PNC by day 7. Key variables studied were maternal complications (during pregnancy, delivery or after delivery) and contact with the health care system (receipt of any antenatal care, place of delivery and type of delivery attendant). Using data from the BMMS 2010 and an Emergency Obstetric and Neonatal Care (EmONC) 2012 needs assessment, we also presented descriptive maps of PNC coverage overlaid with neonatal mortality rates. There were several significant findings from the regression analysis. Newborns of mothers having a skilled delivery were significantly more likely to receive PNC (Day 7: OR = 2.16, 95% confidence interval (CI) 1.81, 2.58; Day 2: OR = 2.11, 95% 95% CI 1.76). Newborns of mothers who reported a complication were also significantly more likely to receive PNC with odds ratios varying between 1.3 and 1.6 for complications at the different points along the continuum of care. Urban residence and greater wealth were also significantly associated with PNC. The maps provided visual images of wide variation in PNC coverage and indicated that districts with the highest PNC coverage, did not necessarily have the lowest neonatal mortality rates. Newborns of mothers who had a skilled delivery or who experienced a complication were more likely to receive PNC than newborns of mothers with a home delivery or who did
Lieshout, J. van; Frigola Capell, E.; Ludt, S.; Grol, R.P.T.M.; Wensing, M.J.P.
OBJECTIVES: Cardiovascular risk management (CVRM) received by patients shows large variation across countries. In this study we explored the aspects of primary care organisation associated with key components of CVRM in coronary heart disease (CHD) patients. DESIGN: Observational study. SETTING: 273 primary care practices in Austria, Belgium, England, Finland, France, Germany, The Netherlands, Slovenia, Switzerland and Spain. PARTICIPANTS: A random sample of 4563 CHD patients identified by co...
Cicekci, Faruk; Duran, Numan; Ayhan, Bunyamin; Arican, Sule; Ilban, Omur; Kara, Iskender; Turkoglu, Melda; Yildirim, Fatma; Hasirci, Ismail; Karaibrahimoglu, Adnan; Kara, Inci
Patients in intensive care units (ICUs) are often physically unable to communicate with their physicians. Thus, the sharing of information about the on-going treatment of the patients in ICUs is directly related to the communication attitudes governing a patient's relatives and the physician. This study aims to analyze the attitudes displayed by the relatives of patients and the physician with the purpose of determining the communication between the two parties. For data collection, two similar survey forms were created in context of the study; one for the relatives of the patients and one for the ICU physicians. The questionnaire included three sub-dimensions: informing, empathy and trust. The study included 181 patient relatives and 103 ICU physicians from three different cities and six hospitals. Based on the results of the questionnaire, identification of the mutual expectations and substance of the messages involved in the communication process between the ICU patients' relatives and physicians was made. The gender and various disciplines of the physicians and the time of the conversation with the patients' relatives were found to affect the communication attitude towards the patient. Moreover, the age of the patient's relatives, the level of education, the physician's perception, and the contact frequency with the patient when he/she was healthy were also proven to have an impact on the communication attitude of the physician. This study demonstrates the mutual expectations and substance of messages in the informing, empathy and trust sub-dimensions of the communication process between patient relatives and physicians in the ICU. The communication between patient relatives and physicians can be strengthened through a variety of training programs to improve communication skills.
Tim R de Back
Full Text Available Studies regularly show a higher incidence, prevalence and mortality of cardiovascular disease among immigrant groups from low-income countries. Despite residing in the Netherlands for over 60 years, the Moluccan-Dutch cardiovascular disease profile and health care use are still unknown. We aimed to compare (a the clinical prevalence of cardiovascular diseases and (b the use of health care services by cardiovascular disease patients of 5,532 Moluccan-Dutch to an age-sex matched control group of 55,320 native Dutch.We performed a cross-sectional analysis of data of the Achmea health insurance company for the period of 1 January 2009 to 31 December 2010. We collected information on health care use, including diagnostic information. Linear and logistic regression models were used for comparison.Moluccans had a higher clinical prevalence of ischemic heart diseases (odds ratio 1.26; 95% confidence interval 1.03-1.56, but tended to have a lower prevalence of cerebrovascular accidents (0.79; 0.56-1.11 and cardiac failure (0.67; 0.44-1.03. The clinical prevalence of cardiovascular diseases together tended to be lower among Moluccans (0.90; 0.80-1.00. Consultation of medical specialists did not differ. Angiotensin II inhibitors (1.42; 1.09-1.84, antiplatelet agents (1.27; 1.01-1.59 and statins (1.27; 1.00-1.60 were prescribed more frequently to Moluccans, as were cardiovascular agents in general (1.27; 0.94-1.71.The experience of Moluccans in the Netherlands suggests that, in the long run, cardiovascular risk and related health care use of ethnic minority groups may converge towards that of the majority population.
Utz, Bettina; Assarag, Bouchra; Essolbi, Amina; Barkat, Amina; Delamou, Alexandre; De Brouwere, Vincent
The objective of this study was to assess knowledge and practices of general practitioners, nurses and midwives working at primary health care facilities in Morocco regarding screening and management of gestational diabetes (GDM). Structured interviews with 100 doctors, midwives and nurses at 44 randomly selected public health care centers were conducted in Marrakech and Al Haouz. All data were descriptively analyzed. Ethical approval for the study was granted by the institutional review boards in Belgium and Morocco. Public primary health care providers have a basic understanding of gestational diabetes but screening and management practices are not uniform. Although 56.8% of the doctors had some pre-service training on gestational diabetes, most nurses and midwives lack such training. After diagnosing GDM, 88.5% of providers refer patients to specialists, only 11.5% treat them as outpatients. Updating knowledge and skills of providers through both pre- and in-service-training needs to be supported by uniform national standards enabling first line health care workers to manage women with GDM and thus increase access and provide a continuity in care. Findings of this study will be used to pilot a model of GDM screening and initial management through the primary level of care. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Bruna de Oliveira Ascef
Full Text Available ABSTRACT OBJECTIVE To analyze the Health-Related Quality of Life (HRQoL of patients of the primary health care of the Brazilian Unified Health System (SUS and its associated factors. METHODS This is a cross-sectional study with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015. Data were collected with a questionnaire that included the EuroQol 5 Dimensions (EQ-5D instrument. Patients from the five regions of Brazil were interviewed. Multiple linear regression was used to analyze their Health-Related Quality of Life and its associated factors. RESULTS Of the total of 8,590 patients, the most frequent dimensions were pain/discomfort (50.7% and anxiety/depression (38.8%. About 10% of the patients reported extreme problems in these dimensions. The following factors were significantly associated with a worse quality of life: being female; having arthritis, osteoarthritis, or rheumatism; cerebrovascular accident; heart disease; depression; health self-assessment as poor or very poor; drinking alcoholic beverages once or more per month; dieting to lose weight, avoiding salt consumption, and reducing fat intake. Significant association was observed between a better quality of life and: living in the North and Southeast regions of Brazil; practicing physical activities; and having a higher educational level. No association was observed with factors related to the health services. CONCLUSIONS The Health-Related Quality of Life of patients was influenced by demographic and socioeconomic factors that were related to health conditions and lifestyle, being useful to guide specific actions for promoting health and the integral care to patients of the Brazilian Unified Health System.
van Mol, Margo M C; Nijkamp, Marjan D; Bakker, Jan; Schaufeli, Wilmar B; Kompanje, Erwin J O
Working in an Intensive Care Unit (ICU) is increasingly complex and is also physically, cognitively and emotionally demanding. Although the negative emotions of work-related stress have been well studied, the opposite perspective of work engagement might also provide valuable insight into how these emotional demands may be countered. This study focused on the work engagement of ICU professionals and explored the complex relationship between work engagement, job demands and advantageous personal resources. This was a cross-sectional survey study among ICU professionals in a single-centre university hospital. Work engagement was measured by the Utrecht Work Engagement Scale, which included items about opinions related to the respondent's work environment. Additionally, 14 items based on the Jefferson Scale of Physician Empathy were included to measure empathic ability. A digital link to the questionnaire was sent in October 2015 to a population of 262 ICU nurses and 53 intensivists. The overall response rate was 61% (n=193). Work engagement was negatively related both to cognitive demands among intensivists and to emotional demands among ICU nurses. No significant relationship was found between work engagement and empathic ability; however, agreeableness, conscientiousness, and emotional stability were highly correlated with work engagement. Only the number of hours worked per week remained as a confounding factor, with a negative effect of workload on work engagement after controlling for the effect of weekly working hours. Work engagement counterbalances work-related stress reactions. The relatively high workload in ICUs, coupled with an especially heavy emotional burden, may be acknowledged as an integral part of ICU work. This workload does not affect the level of work engagement, which was high for both intensivists and nurses despite the known high job demands. Specific factors that contribute to a healthy and successful work life among ICU professionals need
Artioli, Giovanna; Finotto, Stefano; Paverelli, Luisa; Carpanoni, Marika; Casadei, Elena Turroni
All the scientific literature agrees on the fact that the shelter in hospital is a delicate moment for the patient. Also for relatives the shelter in hospital of their dear one is not of easy management, often they are excluded, insecure, alone and with a frankly uncertain role. The purpose of this study is to explore the role and the needs perceived from the relatives of an in-patient in a general medicine unit and to explore which role and which needs of the relatives are perceived from the nurses of a same ward. The sample of the study consisted of 49 relatives of in-patients in the ward of Medicina III dell'Azienda Ospedaliera di Reggio Emilia and of 18 nurses of the same ward. It was found that information is the most important need expressed by the relatives and that for the nurses is hard to satisfy it. Moreover, the nurses haven't a clear idea of the relative's role and they are inclined to exclude them from the care project.
Eva Ekvall Hansson
Full Text Available Eva Ekvall Hansson1, Eva Håkansson2, Annelie Raushed2, Anders Håkansson1 1Lund University, Department of Clinical Sciences in Malmö/General Practice, Malmö, Sweden; 2Primary Health Care Malmö, SwedenObjective: To describe a multidisciplinary program, given by an occupational therapist and a physiotherapist, for patients with stress-related disease in primary health care and to measure the effect of this program in terms of self-perceived health, degree of burnout, physical activity, symptoms, recreational activities, and psychological and physical well-being.Method: Retrospective study.Results: At measures after three months, the thirteen patients included in this study had improved in self-estimated health, measured with EuroQol-5D Visual Analogue Scale (p = 0.000, and in degree of burnout, measured with the Shirom–Melamed Burnout Questionnaire (p = 0.001. There was also a decrease in presence of headache, in physical activity and in satisfaction with leisure time, although not statistically significant. After six months, the improvements remained for all measures except physical activity. The patients were also satisfied with the program to a high degree, measured with Client Satisfaction Questionnaire (median 3.7.Conclusion: This descriptive study shows that a stress-management program, provided by a team including an occupational therapist and a physiotherapist in primary health care, is both feasible and effective in terms of self-estimated health, degree of burnout, and patient satisfaction. Keywords: stress-related health, burnout, occupational therapy, physiotherapy
Allingstrup, Matilde Jo; Esmailzadeh, Negar; Knudsen, Anne Wilkens
, also when adjusted for baseline prognostic variables (APACHE II, SOFA scores and age). Provision of energy, measured resting energy expenditure or energy and nitrogen balance was not related to mortality. The possible cause-effect relationship is discussed after a more detailed analysis of the initial......BACKGROUND & AIMS: Adequacy of nutritional support in intensive care patients is still a matter of investigation. This study aimed to relate mortality to provision, measured requirements and balances for energy and protein in ICU patients. DESIGN: Prospective observational cohort study of 113 ICU...... part of the admission. CONCLUSION: In these severely ill ICU patients, a higher provision of protein and amino acids was associated with a lower mortality. This was not the case for provision of energy or measured resting energy expenditure or energy or nitrogen balances. The hypothesis that higher...
Groen-van de Ven, Leontine; Smits, Carolien; Oldewarris, Karen; Span, Marijke; Jukema, Jan; Eefsting, Jan; Vernooij-Dassen, Myrra
This prospective multiperspective study provides insight into the decision trajectories of people with dementia by studying the decisions made and related key events. This study includes three waves of interviews, conducted between July 2010 and July 2012, with 113 purposefully selected respondents (people with beginning to advanced stages of dementia and their informal and professional caregivers) completed in 12 months (285 interviews). Our multilayered qualitative analysis consists of content analysis, timeline methods, and constant comparison. Four decision themes emerged-managing daily life, arranging support, community living, and preparing for the future. Eight key events delineate the decision trajectories of people with dementia. Decisions and key events differ between people with dementia living alone and living with a caregiver. Our study clarifies that decisions relate not only to the disease but to living with the dementia. Individual differences in decision content and sequence may effect shared decision-making and advance care planning.
Stephens, John R; Steiner, Michael J; DeJong, Neal; Rodean, Jonathan; Hall, Matt; Richardson, Troy; Berry, Jay G
We studied constipation-related health care among children before and after constipation admission. Index admissions for constipation in 2010-2011 were identified in the Truven Marketscan Database, which includes children receiving Medicaid in 10 states. We measured number of and spending for outpatient constipation visits 12 months before and after index hospitalizations. We also measured spending for constipation hospitalizations and rehospitalization rate. There were 780 index constipation admissions. The median number of outpatient constipation visits was 1 (interquartile range [IQR] = 0, 3) in the 12 months before and 2 (IQR [0, 4]) after admission ( P = .001). Median outpatient spending for constipation was $110 (IQR [0, 429]) before and $132 (IQR [0, 431]) after admission ( P = .2). Median spending for index constipation admissions was $5295 (IQR [2756, 8267]); 78 children (10%) were rehospitalized for constipation within 12 months. Constipation-related health care utilization increased after constipation admission. Median spending for one constipation admission was 50 times the median spending for 12 months of outpatient constipation visits.
Lagman, Ruth L; Walsh, Declan; Davis, Mellar P; Young, Brett
The All Patient Refined-Diagnostic Related Group (APR-DRG) is a modification of the traditional DRG that adds four classes of illness severity and four classes of mortality risk. The APR-DRG is a more accurate assessment of the complexity of care. When individuals with advanced illness are admitted to an acute inpatient palliative medicine unit, there may be a perception that they receive less intense acute care. Most of these patients, however, are multisymptomatic, have several comorbidities, and are older. For all patients admitted to the unit, a guide was followed by staff physicians to document clinical information that included the site(s) of malignancy, site(s) of metastases, disease complications, disease-related symptoms, and comorbidities. We then prospectively compared DRGs, APR-DRGs, and case mix index (CMI) from January 1-June 30, 2003, and February 1-July 31,2004, before and after the use of the guide. The overall mean severity of illness (ASOI) increased by 25% (P DRG classifications captured a higher severity of illness and may better reflect resource utilization.
Suhonen, Marjo; Paasivaara, Leena
To explore factors of human capital related to project success that employees expect from nurse managers. Human capital refers to those resources that managers working with projects possess, such as abilities, knowledge and qualities of character. The data were collected by open interviews (n=14) with nurses, public health nurses and nurse managers working in primary health care and a hospital. Data analysis was carried out using qualitative content analysis. The main factors of human capital related to project success proved to be as follows: (1) management of enthusiastic project culture, (2) management of regeneration and (3) management of emotional intelligence. Future research is needed on the kind of means nurse managers use in human capital management in projects and how they see their possibilities in managing human capital. Human capital management skills should be underlined as an important competence area when recruiting a nurse manager. The success of health care projects cannot be improved only through education or by training of nurse managers; in addition, projects need nurse managers who understand workplace spirituality and have high emotional intelligence. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.
In Young Jung
Full Text Available Background. Adverse drug reactions (ADRs are any unwanted/uncomfortable effects from medication resulting in physical, mental, and functional injuries. Antibiotics account for up to 40.9% of ADRs and are associated with several serious outcomes. However, few reports on ADRs have evaluated only antimicrobial agents. In this study, we investigated antibiotic-related ADRs at a tertiary care hospital in South Korea. Methods. This is a retrospective cohort study that evaluated ADRs to antibiotics that were reported at a 2400-bed tertiary care hospital in 2015. ADRs reported by physicians, pharmacists, and nurses were reviewed. Clinical information reported ADRs, type of antibiotic, causality assessment, and complications were evaluated. Results. 1,277 (62.8% patients were considered antibiotic-related ADRs based on the World Health Organization-Uppsala Monitoring Center criteria (certain, 2.2%; probable, 35.7%; and possible, 62.1%. Totally, 44 (3.4% patients experienced serious ADRs. Penicillin and quinolones were the most common drugs reported to induce ADRs (both 16.0%, followed by third-generation cephalosporins (14.9%. The most frequently experienced side effects were skin manifestations (45.1% followed by gastrointestinal disorders (32.6%. Conclusion. Penicillin and quinolones are the most common causative antibiotics for ADRs and skin manifestations were the most frequently experienced symptom.
Morgan, Debra G.; Kosteniuk, Julie G.; O'Connell, Megan E.; Dal Bello-Haas, Vanina; Stewart, Norma J.; Karunanayake, Chandima
An understanding of the specific dementia learning needs of home care staff is needed to plan relevant continuing education (CE) programs and supports. The study's objective was to examine frequency and perceived competence in performing 20 dementia-related work activities, and identify CE priorities among home care staff. A cross-sectional survey…
Rodriguez-Sanchez, Emiliano; Patino-Alonso, Maria C.; Mora-Simon, Sara; Gomez-Marcos, Manuel A.; Perez-Penaranda, Anibal; Losada-Baltar, Andres; Garcia-Ortiz, Luis
Purpose: To assess, in the context of Primary Health Care (PHC), the effect of a psychological intervention in mental health among caregivers (CGs) of dependent relatives. Design and Methods: Randomized multicenter, controlled clinical trial. The 125 CGs included in the trial were receiving health care in PHC. Inclusion criteria: Identifying…
N.J.H. Raijmakers (Natasja)
textabstractEnd-of-life care aims to improve quality of life of patients and their relatives facing problems associated with life-threatening illness in the last days of life. End-of-life decision-making is an important aspect of end-of-life care that can have a significant impact on the process of
Jacobson, Sandra A; Simpson, Rachel G; Lubahn, Cheri; Hu, Chengcheng; Belden, Christine M; Davis, Kathryn J; Nicholson, Lisa R; Long, Kathy E; Osredkar, Tracy; Lorton, Dianne
Fibromyalgia (FM) has been understudied in the elderly population, a group with particular vulnerabilities to pain, reduced mobility, and sleep disruption. To characterize FM symptoms and treatments in a cohort of older subjects examined over time to determine the extent to which current, community-based treatment for older FM patients is in accord with published guidelines, and effective in reducing symptoms. A longitudinal, observational study of 51 subjects with FM (range 55-95 years) and 81 control subjects (58-95 years) performed at Banner Sun Health Research Institute in Sun City, AZ, USA. Serial history and examination data were obtained over a 6-year period. FM data included medical history, medications, physical examination, tender point examination, neuropsychological testing, sleep and pain ratings, the Physical Function Subscale of the Fibromyalgia Impact Questionnaire, and other standardized scales to evaluate depression and other psychiatric symptoms, and cognitive and functional impairment. Pain and stiffness that interfered with physical activity, sleep, and mood were reported by 80 % or more of subjects. Over time, pain involved an increasing number of body areas. Over half of subjects were treated with NSAIDs, one-quarter with opioids, and one-quarter with estrogen. Few were treated with dual-acting antidepressants or pregabalin. In this cohort of elders with suboptimally treated FM, substantial persistence of symptoms was seen over time. In general, recommended treatments were either not used or not tolerated. Age-appropriate treatments as well as education of primary care providers are needed to improve treatment of FM in the older population.
Lewis, Kelsey Lackey; John, Barnabas; Condren, Michelle; Carter, Sandra M
BACKGROUND: As the life expectancy of patients with cystic fibrosis (CF) increases, the focus on ensuring success with medication therapies is increasingly important. The ability of patients to autonomously manage medications and related therapies is poorly described in the literature. OBJECTIVE: The goal of this project was to assess the level of medication-related knowledge and self-care skills in patients with CF. METHODS: This project took place in a Cystic Fibrosis Foundation accredited affiliate center. Eighty-nine patients between the ages of 6 and 60 were eligible to participate based on inclusion and exclusion criteria. Pharmacists administered a 16-item questionnaire and detailed medication history during clinic visits from January through May 2014. RESULTS: Forty-five patients 6 to 41 years old participated in the study. The skills most often performed independently were preparing nebulizer treatments (85%) and telling someone if they feel their medicines are causing a problem (89%). Skills least often performed were carrying a medication list (82%) and bringing a medication list to appointments (76%). In respondents 21 years of age and older, less than 75% of respondents were involved with obtaining financial resources, maintaining equipment, carrying a medication list, or rinsing their mouth after using inhaled medicines. Participants were able to provide drug name, dose, and frequency of use for pancreatic enzymes and azithromycin 37% and 24% of the time, respectively. CONCLUSIONS: In the population surveyed, many medication-related skills had not been acquired by early adulthood. Assessing and providing education for medication-related self-care skills at all ages are needed.
Steel, Ben J
The oral health of older people in acute hospitals has rarely been studied. Hospital admission provides a prime opportunity for identification and rectification of problems, and oral health promotion. This two-part article explores oral hygiene and mouth care provision for older adults in acute hospitals. The first article presents the findings of a literature review exploring oral and dental disease in older adults, the importance of good oral health and mouth care, and the current situation. Searches of electronic databases and the websites of relevant professional health service bodies in the UK were undertaken to identify articles and guidelines. The literature shows a high prevalence of oro-dental disease in this population, with many known detrimental effects, combined with suboptimal oral hygiene and mouth care provision in acute hospitals. Several guidelines exist, although the emphasis on oral health is weaker than other aspects of hospital care. Older adults admitted to acute hospitals have a high burden of oro-dental disease and oral and mouth care needs, but care provision tends to be suboptimal. The literature is growing, but this area is still relatively neglected. Great potential exists to develop oral and mouth care in this context. The second part of this article explores clinical recommendations. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.
Warpenius, Erika; Alasaarela, Esko; Sorvoja, Hannu; Kinnunen, Matti
As the number of elderly people rises, relatives' care-taking responsibilities increase accordingly. This creates a need for developing new systems that enable relatives to keep track of aged family members. To develop new mobile services for elderly healthcare we tried to identify the most wanted features of a mobile user-interface from the perspective of relatives. Feature mapping was based on two online surveys: one administered to the relatives (N = 32) and nurses (N = 3) of senior citizens and the other to nursing students (N = 18). Results of the surveys, confirmed by face-to-face interviews of the relatives (N = 8), indicated that the most valued features of the mobile user-interface are Accident Reporting (e.g. falling), Alarms (e.g. fire-alarm), Doctor Visits and evaluation of the General Condition of the Senior. The averaged importance ratings of these features were 9.2, 9.0, 8.6 and 8.5, respectively (on a scale from 0 to 10). Other important considerations for the user-interface development are aspiration to simplicity and ease-of-use. We recommend that the results are taken into account, when designing and implementing mobile services for elderly healthcare.
Full Text Available Abstract Objectives 1 To design and validate indicators to measure the quality of the process of care that climacteric stage women receive in family medicine clinics (FMC. 2 To assess the quality of care that climacteric stage women receive in FMC. 3 To determine the association between quality of care and health-related quality of life (HR-QoL among climacteric stage women. Methods The study had two phases: I. Design and validation of indicators to measure the quality of care process by using the RAND/UCLA Appropriateness Method. II. Evaluation of the quality of care and its association with HR-QoL through a cross-sectional study conducted in two FMC located in Mexico City that included 410 climacteric stage women. The quality of care was measured by estimating the percentage of recommended care received (PRCR by climacteric stage women in three process components: health promotion, screening, and treatment. The HR-QoL was measured using the Cervantes scale (0-155. The association between quality of care and HR-QoL was estimated through multiple linear regression analysis. Results The lowest mean of PRCR was for the health promotion component (24.1% and the highest for the treatment component (86.6%. The mean of HR-QoL was 50.1 points. The regression analysis showed that in the treatment component, for every 10 additional points of the PRCR, the global HR-QoL improved 2.8 points on the Cervantes scale (coefficient -0.28, P Conclusion The indicators to measure quality of care for climacteric stage women are applicable and feasible in family medicine settings. There is a positive association between the quality of the treatment component and HR-QoL; this would encourage interventions to improve quality of care for climacteric stage women.
Adsersen, Mathilde; Thygesen, Lau Caspar; Jensen, Anders Bonde
/units. Patients with brain cancer were more often admitted to hospices, whereas patients with prostate cancer were more often admitted to hospital-based palliative care teams/units. CONCLUSION: It is unlikely that the variations in relation to sex, age and cancer diagnoses can be fully explained by differences...... to investigate whether cancer patients' admittance to SPC in Denmark varied in relation to sex, age and diagnosis, and whether the patterns differed by type of institution (hospital-based palliative care team/unit, hospice, or both). METHODS: This was a register-based study of adult patients living in Denmark......BACKGROUND: Specialised palliative care (SPC) takes place in specialised services for patients with complex symptoms and problems. Little is known about what determines the admission of patients to SPC and whether there are differences in relation to institution type. The aims of the study were...
Tesler Laura E
Full Text Available Abstract Background With the transition to neoliberalism, Nicaragua's once-critically acclaimed health care services have substantially diminished. Local level social formations have been under pressure to try to bridge gaps as the state's role in the provision of health care and other vital social services has decreased. This paper presents a case study of how global and national health policies reverberated in the social relations of an extended network of female kin in a rural community during late 2002 - 2003. Methods The qualitative methods used in this ethnographic study included semi-structured interviews completed during bi-weekly visits to 51 households, background interviews with 20 lay and professional health practitioners working in the public and private sectors, and participant-observation conducted in the region's government health centers. Interviews and observational field notes were manually coded and iteratively reviewed to identify and conceptually organize emergent themes. Three households of extended kin were selected from the larger sample to examine as a case study. Results The ongoing erosion of vital services formerly provided by the public sector generated considerable frustration and tension among households, networks of extended kin, and neighbors. As resource allocations for health care seeking and other needs were negotiated within and across households, longstanding ideals of reciprocal exchange persisted, but in conditions of poverty, expectations were often unfulfilled, exposing the tension between the need for social support, versus the increasingly oppositional positioning of social network members as sources of competition for limited resources. Conclusions In compliance with neoliberal structural adjustment policies mandated by multilateral and bilateral agencies, government-provided health care services have been severely restricted in Nicaragua. As the national safety net for health care has been eroded
Background With the transition to neoliberalism, Nicaragua's once-critically acclaimed health care services have substantially diminished. Local level social formations have been under pressure to try to bridge gaps as the state's role in the provision of health care and other vital social services has decreased. This paper presents a case study of how global and national health policies reverberated in the social relations of an extended network of female kin in a rural community during late 2002 - 2003. Methods The qualitative methods used in this ethnographic study included semi-structured interviews completed during bi-weekly visits to 51 households, background interviews with 20 lay and professional health practitioners working in the public and private sectors, and participant-observation conducted in the region's government health centers. Interviews and observational field notes were manually coded and iteratively reviewed to identify and conceptually organize emergent themes. Three households of extended kin were selected from the larger sample to examine as a case study. Results The ongoing erosion of vital services formerly provided by the public sector generated considerable frustration and tension among households, networks of extended kin, and neighbors. As resource allocations for health care seeking and other needs were negotiated within and across households, longstanding ideals of reciprocal exchange persisted, but in conditions of poverty, expectations were often unfulfilled, exposing the tension between the need for social support, versus the increasingly oppositional positioning of social network members as sources of competition for limited resources. Conclusions In compliance with neoliberal structural adjustment policies mandated by multilateral and bilateral agencies, government-provided health care services have been severely restricted in Nicaragua. As the national safety net for health care has been eroded, the viability of local level
Tesler, Laura E
With the transition to neoliberalism, Nicaragua's once-critically acclaimed health care services have substantially diminished. Local level social formations have been under pressure to try to bridge gaps as the state's role in the provision of health care and other vital social services has decreased. This paper presents a case study of how global and national health policies reverberated in the social relations of an extended network of female kin in a rural community during late 2002 - 2003. The qualitative methods used in this ethnographic study included semi-structured interviews completed during bi-weekly visits to 51 households, background interviews with 20 lay and professional health practitioners working in the public and private sectors, and participant-observation conducted in the region's government health centers. Interviews and observational field notes were manually coded and iteratively reviewed to identify and conceptually organize emergent themes. Three households of extended kin were selected from the larger sample to examine as a case study. The ongoing erosion of vital services formerly provided by the public sector generated considerable frustration and tension among households, networks of extended kin, and neighbors. As resource allocations for health care seeking and other needs were negotiated within and across households, longstanding ideals of reciprocal exchange persisted, but in conditions of poverty, expectations were often unfulfilled, exposing the tension between the need for social support, versus the increasingly oppositional positioning of social network members as sources of competition for limited resources. In compliance with neoliberal structural adjustment policies mandated by multilateral and bilateral agencies, government-provided health care services have been severely restricted in Nicaragua. As the national safety net for health care has been eroded, the viability of local level social formations and their ability to
Kunze, H. E.; Hicken, J. E.; Vrscay, E. R.
Broad classes of inverse problems in differential and integral equations can be cast in the following framework: the optimal approximation of a target x of a suitable metric space X by the fixed point \\bar x of a contraction map T on X. The 'collage method' attempts to solve such inverse problems by finding an operator Tc that maps the target x as close as possible to itself. In the case of ODEs, the appropriate contraction maps are integral Picard operators. In practice, the target solutions possibly arise from an interpolation of experimental data points. In this paper, we investigate the suboptimality of the collage method. A simple inequality that provides upper bounds on the improvement over collage coding is presented and some examples are studied. We conclude that, at worst, the collage method provides an excellent starting point for further optimization, in contrast to more traditional searching methods that must first select a good starting point.
Full Text Available A suboptimal partial transmit sequence (PTS based on particle swarm optimization (PSO algorithm is presented for the low computation complexity and the reduction of the peak-to-average power ratio (PAPR of an orthogonal frequency division multiplexing (OFDM system. In general, PTS technique can improve the PAPR statistics of an OFDM system. However, it will come with an exhaustive search over all combinations of allowed phase weighting factors and the search complexity increasing exponentially with the number of subblocks. In this paper, we work around potentially computational intractability; the proposed PSO scheme exploits heuristics to search the optimal combination of phase factors with low complexity. Simulation results show that the new technique can effectively reduce the computation complexity and PAPR reduction.
Full Text Available Abstract A suboptimal partial transmit sequence (PTS based on particle swarm optimization (PSO algorithm is presented for the low computation complexity and the reduction of the peak-to-average power ratio (PAPR of an orthogonal frequency division multiplexing (OFDM system. In general, PTS technique can improve the PAPR statistics of an OFDM system. However, it will come with an exhaustive search over all combinations of allowed phase weighting factors and the search complexity increasing exponentially with the number of subblocks. In this paper, we work around potentially computational intractability; the proposed PSO scheme exploits heuristics to search the optimal combination of phase factors with low complexity. Simulation results show that the new technique can effectively reduce the computation complexity and PAPR reduction.
Sørensen, Lin; Sonuga-Barke, Edmund; Eichele, Heike
Objective: Suboptimal decision making in the face of risk (DMR) in children with attention-deficit hyperactivity disorder (ADHD) may be mediated by deficits in a number of different neuropsychological processes. We investigated DMR in children with ADHD using the Cambridge Gambling Task (CGT......-matched group of typically developing children (n = 34) performed the CGT. Results: As predicted, children with ADHD were not more prone to making risky choices (i.e., risk proneness). However, they had difficulty adjusting to changing risk levels and were more delay aversive-with these 2 effects being...... correlated. Conclusions: Our findings add to the growing body of evidence that children with ADHD do not favor risk taking per se when performing gambling tasks, but rather may lack the cognitive skills or motivational style to appraise changing patterns of risk effectively....
Juthberg, Christina; Eriksson, Sture; Norberg, Astrid; Sundin, Karin
The aim was to study the relationship between conscience and burnout among care-providers in older care, exploring the relationship between stress of conscience and burnout, and between perceptions of conscience and burnout. Everyday work in healthcare presents situations that influence care-providers' conscience. How care-providers perceive conscience has been shown to be related to stress of conscience (stress related to troubled conscience), and in county council care, an association between stress of conscience and burnout has been found. A questionnaire study was conducted in municipal housing for older people. A total of 166 care-providers were approached, of which 146 (50 registered nurses and 96 nurses' aides/enrolled nurses) completed a questionnaire folder containing the stress of conscience questionnaire, the perceptions of conscience questionnaire and the maslach burnout inventory. Multivariate canonical correlation analysis was used to explore relationships. The relationship between stress of conscience and burnout indicates that experiences of shortcomings and of being exposed to contradictory demands are strongly related to burnout (primarily to emotional exhaustion). The relationship between perceptions of conscience and burnout indicates that a deadened conscience is strongly related to burnout. Conscience seems to be of importance in relation to burnout, and suppressing conscience may result in a profound loss of wholeness, integrity and harmony in the self. The results from our study could be used to raise awareness of the importance of conscience in care.
Santos, Vera Lucia Conceição de Gouveia; Augusto, Fabiana da Silva; Gomboski, Gustavo
We examined health-related quality of life (HRQOL) in persons with ostomies receiving outpatient care. We also analyzed relationships among HRQOL, demographic, and pertinent clinical factors. We used a descriptive, exploratory, cross-sectional study design to collect and analyze data. Data in this article are a secondary analysis of data collected from a primary study, developed by Santos and Gomboski, on the adaptation and validation of the City of Hope-Quality of Life-Ostomy Questionnaire (COH-QOL-OQ) to the Portuguese language in Brazil. A convenience sample of 215 adults living with an ostomy was evaluated. Slightly more than half (51.6%) were men, 67.5% underwent colostomy surgery, and 59.1% underwent cancer-related ostomy surgery. Subjects received care in specialized health care units in 3 cities in the Brazilian state of Rio Grande do Sul. After approval by the Research Ethics Committee and permission from health care units, data were collected using 2 instruments: the World Health Organization Quality of Life-Short Version (WHOQOL-Bref) (generic HRQOL instrument) and the COH-QOL-OQ (disease specific HRQOL instrument). Data were analyzed using χ test and logistic regression (via a stepwise forward method). Patients were classified into 3 groups according to the means and standard deviations of the scores: low, moderate, and high quality of life (QOL). Ostomy patients had total scores of 69.6 ± 20.2 and 6.1 ± 1.4 for the WHOQOL-Bref and COH-QOL-OQ instruments, respectively. Patients with shorter times since their ostomy creation had worse scores on both the specific QOL (P = .006) and generic QOL (P = .019) instruments. Patients who did not practice religion (P = .027; odds ratio [OR] = 3.39) and those without a partner/spouse (P = .007; OR = 4.90) had increased probability of having worse scores on the WHOQOL-Bref (generic instrument). Persons living with ostomies were found to have scores indicating moderate HRQOL on a disease-specific and generic
Salilew-Wondim, Dessie; Tesfaye, Dawit; Hoelker, Michael; Schellander, Karl
After its formation, the mammalian zygote undergoes a series of morphological, physiological and biochemical alterations prior to undergoing cell differentiation. The zygote is then transformed into a complex multicellular organism in a defined time window which may differ between species. These orderly embryonic developmental events are tightly regulated by temporal and spatial activation and/or deactivation of genes and gene products. This phenomenon may in turn be dependent on the intrinsic characteristics of the embryo itself, the physiological and biochemical composition of the maternal environment or by in vitro culture condition. In fact, when embryos are subjected to suboptimal culture condition, some of the embryos may escape the environmental stress by activating certain transcripts and some others which are unable to activate anti-stress agents may die or exhibit abnormal development. This phenomenon may partly depend on transcripts and proteins stored during oogenesis. Indeed after embryonic genome activation, the embryo destiny is governed by its own transcripts and protein synthesized over time. Therefore, this review begins by highlighting the type and quality of transcripts accumulated or degraded during oogenesis and its impact on the embryo survival. Thereafter, emphasis is given to the transcriptome response of preimplantation embryos to suboptimal culture conditions. In addition, the long term effect of preimplantation culture environment on the transcriptome response embryos/fetus during peri and post implantation has been addressed. Finally, a brief summary of the epigenetic control of culture induced genetic variation of the embryos has been highlighted. Copyright © 2014 Elsevier B.V. All rights reserved.
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ENGLISH ABSTRACT: This research presents a methodology for determining the optimal location of a new facility, having physical flow interaction of various degrees with other existing facilities in the presence of barriers impeding the shortest flow-path as well as the sub-optimal iso-cost positions. It also determines sub-optimal iso-cost positions with additional cost or penalty for not being able to site it at the computed optimal point. The proposed methodology considers all types of quadrilateral barrier or forbidden region configurations to generalize and by-pass such impenetrable obstacles, and adopts a scheme of searching through the vertices of the quadrilaterals to determine the alternative shortest flow-path. This procedure of obstacle avoidance is novel. Software has been developed to facilitate computations for the search algorithm to determine the optimal and iso-cost co-ordinates. The test results are presented.
AFRIKAANSE OPSOMMING: Die navorsing behandel ‘n procedure vir die bepaling van optimum stigtingsposisie vir ‘n onderneming met vloei vanaf ander bestaande fasiliteite in die teenwoordigheid van ‘n verskeidenheid van randvoorwaardes. Die prodedure lewer as resultaat suboptimale isokoste-stigtingsplekke met bekendmaking van die koste wat onstaan a.g.v. afwyking van die randvoorwaardlose optimum oplossingskoste, die prosedure maak gebruik van ‘n vindingryke soekmetode wat toegepas word op niersydige meerkundige voorstellings vir die bepaling van korste roetes wat versperring omseil. Die prosedure word onderskei deur programmatuur. Toetsresultate word voorgehou.
Catheter-related infection (CRI) surveillance is advocated as a healthcare quality indicator. However, there is no national CRI surveillance programme or standardized CRI definitions in Irish intensive care units (ICUs).
Collignon, Julien; Rouch, Isabelle; Gonthier, Régis; Corbin-Seguin, Aude; Combe, Lorraine; Trombert-Paviot, Béatrice; Laurent, Bernard; Girtanner, Chantal
Refusal of care and support in these patients with Alzheimer's disease and related illnesses at home is a cause of accelerated loss of autonomy and increases the risk of a crisis with early institutionalization. Factors contributing to the denial of care are poorly understood and very few epidemiological data exist. we compared age, diagnosis, level of severity of the disease, the type of behavioral, family status of 101 patients living in denial of care and support as seen by a mobile home (group UPEPc) to 136 control patients seen at the memory clinic (group CM). Patients living in denial of care appear to significantly low age [82/80.5, prefusing home care is specific and it is important to educate GPs conditions that favor an obstacle to medicalization. The advantage of a mobile extramural to analyze risk factors for refusal of care and propose alternatives should be further investigated.
Goldstein, Eric; Ho, Chuan-Xing; Hanna, Rania; Elinger, Clara; Yaremchuk, Kathleen L; Seidman, Michael D; Jesse, Michelle T
A consistent management algorithm for subjective tinnitus remains to be elucidated. Chronic tinnitus yields approximately US$2110 in annual health care costs per patient. However, it is unclear whether spending more in the management of tinnitus equates with greater patient satisfaction. Thus, the aim of this study is to correlate patient satisfaction with patient demographics, provider recommendations, and total health care-related expenditures. A retrospective chart review and a patient satisfaction questionnaire. All data were collected from a large Midwestern hospital. Patients were included who presented to the tinnitus clinic during the year 2011 and were between the ages of 18 and 89 years. They were excluded with diagnoses of Ménière's disease, pulsatile tinnitus, acoustic neuromas, or autoimmune inner ear diseases. The retrospective data and satisfaction surveys were entered by 3 of the authors. Responses were based on Likert scales. Of the 692 patients included, 230 completed and returned the satisfaction questionnaire (33.2% response rate), yielding an overall mean of $662.60 charges. The frequency of intervention recommendations per patients ranged from 0 to 13, with a median of 4. Spearman's correlations did not result in significant correlations between patient satisfaction and number of clinic visits (P=.499) or associated charges (P=.453). Given that the variability among provider recommendations, the high overall mean of tinnitus-related charges, and patient satisfaction was not related to costs, further research is needed examining patient preference in the treatment of tinnitus. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Aspelin, Peter; Bergstrand, Lott; Blomqvist, Lennart
Background Outsourcing radiological examinations from public university hospitals affects the patient, who has to attend a different clinic or hospital for the radiological examination. We currently have a limited understanding of how patients view outsourcing and their care related to MR examinations. Aim Aim. To examine the experiences of patients who are sent to private radiology units when their referrals for MR examinations are outsourced from a university hospital, as well as to explore factors which influence patient satisfaction regarding the quality of care related to the MR examination. Methods A group of patients (n = 160) referred for MR examinations and either examined at a university hospital or at an external private unit were interviewed. The interview was designed as a verbal questionnaire. Data were analyzed using Student’s t test, analysis of variance (ANOVA), and Pearson’s correlation. Results Sixty-nine percent of the patients could neither choose nor influence the location at which they were examined. For those who could, aspects that influenced the patient’s choice of radiology department were: short waiting time 79% (127/160), ease of traveling to the radiology department 68% (110/160), and short distance to their home or work 58% (93/160). For 40% (60/160) of the patients, a short time in the waiting room was related to a positive experience of the MR examination. Conclusion Conclusion. If patients were informed about outsourcing and could also choose where to have their examination, key factors contributing to patient satisfaction could be met even when MR examinations are outsourced. PMID:25142133
Brion, John M.; Rose, Carol Dawson; Nicholas, Patrice K.; Sloane, Rick; Voss, Joachim G.; Corless, Inge B.; Lindgren, Teri G.; Wantland, Dean J.; Kemppainen, Jeanne K.; Sefcik, Elizabeth F.; Nokes, Kathleen M.; Kirksey, Kenn M.; Eller, Lucille Sanzero; Hamilton, Mary Jane; Holzemer, William L.; Portillo, Carmen J.; Mendez, Marta Rivero; Robinson, Linda M.; Moezzi, Shanaz; Rosa, Maria; Human, Sarie; Maryland, Mary; Arudo, John; Ros, Ana Viamonte; Nicholas, Thomas P.; Cuca, Yvette; Huang, Emily; Bain, Catherine; Tyer-Viola, Lynda; Zang, Sheryl M.; Shannon, Maureen; Peters-Lewis, Angelleen
The prevalence of symptoms in HIV disease can be associated with HIV disease itself, comorbid illness, and/or antiretroviral therapy. Unhealthy substance use behaviors, particularly substance-use behaviors including heavy alcohol intake, marijuana use, other illicit drug use, and cigarette smoking, are engaged in by many HIV-positive individuals, often as a way to manage disease-related symptoms. This study is a secondary data analysis of baseline data from a larger randomized-controlled trial of an HIV/AIDS Symptom Management Manual. In the present study, the prevalence and characteristics of unhealthy substance use behaviors in relation to HIV/AIDS symptoms are examined. Subjects were recruited from a variety of settings which provide HIV/AIDS care and treatment. The mean age of the sample (n=775) was 42.8 years (SD=9.6) and nearly thirty-nine percent (38.5%) of the sample was female. The racial demographics of the sample were: 28% African American, 28% Hispanic, 21% White/Caucasian, 16% African from Kenya or South Africa, 1% Asian, and 5% self-described as “Other.” The mean number of years living with HIV was reported to be 9.1 years (SD=6.6).Specific self-reported unhealthy substance-use behaviors were use of marijuana (n= 111; 14.3%), cigarette smoking (n=355; 45.8%), heavy alcohol use (n= 66; 8.5%), and illicit drugs (n= 98; 12.6%). A subset of individuals who identified high levels of specific symptoms also reported significantly higher substance use behaviors including amphetamine and injection drug use in addition to heavy alcohol use, cigarette smoking, and marijuana use. Implications for clinical practice include assessment of self-care behaviors, screening for substance abuse, and education of persons related to self-management across the trajectory of HIV disease. PMID:21352430
Patil, Avinash S; Patil, Neelima P; Lewis, Ashley N; Swamy, Geeta K; Murtha, Amy P
To characterize pregnancy and lactation-related medication inquiries to a drug information center to identify classes of medications of most concern to providers. A secondary objective was to identify any trends in provider inquiries over the study period. A retrospective descriptive study of pregnancy and lactation-related inquiries to the University of North Carolina Health Care System Drug Information Center database between January 2001 and December 2010. University of North Carolina Health Care System Drug Information Center. Provider inquiries and responses were extracted and characterized by indication for treatment and reason for inquiry. Comparison of the first and second 5-year periods was performed to delineate trends. Descriptive statistics, Fisher's Exact and χ2 tests were used for analysis. Inquiry origin, time, and subject. 433 inquiries were retrieved over the study period from physicians (50%), pharmacists (21%), and nurses (18%). Inquiries were most often made during the antepartum period (34%), followed by the postpartum (28%) and preconception (22%) periods. The most frequent indications for inquiry were psychiatry (15%) and infectious diseases (14%), which remained constant throughout the study period. Safety was the most common reason for inquiry (52%). The responses provided to callers were limited due to lack of information availability 37% of the time. Psychiatry and infectious disease-related indications are the most frequent subjects of provider inquiry regarding medication use in pregnancy. Rates of inquiry remained constant throughout the past decade in most therapeutic areas. These findings are consistent with previous observations in other developed countries and suggest high-yield areas for pharmacist education.
BACKGROUND: Ambulatory care sensitive conditions (ACSCs) are conditions for which the provision of timely and effective outpatient care can reduce the risks of hospitalisation by preventing, controlling or managing a chronic disease or condition. AIMS: The aims of this study were to report on ACSCs in Ireland, and to provide a baseline for future reference. METHODS: Using HIPE, via Health Atlas Ireland, inpatient discharges classified as ACSCs using definitions from the Victorian ACSC study were extracted for the years 2005-2008. Direct methods of standardisation allowed comparison of rates using the EU standard population as a comparison for national data, and national population as comparison for county data. Costs were estimated using diagnosis-related groups. RESULTS: The directly age-standardised discharge rate for ACSC-related discharges increased slightly, but non-significantly, from 15.40 per 1,000 population in 2005 to 15.75 per 1,000 population in 2008. The number of discharges increased (9.5%) from 63,619 in 2005 to 69,664 in 2008, with the estimated associated hospital costs increasing (31.5%) from
Colville, Gillian A; Smith, Jared G; Brierley, Joe; Citron, Kim; Nguru, Noreen M; Shaunak, Priyanka D; Tam, Olivia; Perkins-Porras, Linda
To examine the associations with symptoms of 1) burnout and 2) work-related posttraumatic stress, in adult and pediatric intensive care staff, focusing on the particular contributions of resilience and coping strategies. Point prevalence cross-sectional study. Three adult ICUs and four PICUs. Three hundred seventy-seven ICU staff. None. Brief Resilience Scale, abbreviated Maslach Burnout Inventory, Trauma Screening Questionnaire, and Hospital Anxiety and Depression Scale. Prevalence of burnout (defined as high emotional exhaustion or high depersonalization) was 37%. Prevalence of clinically significant posttraumatic stress symptoms was 13%. There was a degree of overlap between burnout and other measures of distress, most notably for anxiety (odds ratio, 10.56; 95% CI, 4.12-27.02; p work-related distress (burnout: odds ratio, 0.52; 95% CI, 0.36-0.74; p stress: odds ratio, 0.28; 95% CI, 0.16-0.46; p stress were less if staff used talking to seniors (odds ratio, 0.43; 95% CI, 0.20-0.92; p = 0.029) or hobbies (odds ratio, 0.46; 95% CI, 0.23-0.93; p = 0.030) to cope with stress at work. Venting emotion (odds ratio, 1.92; 95% CI, 1.12-3.31; p = 0.018) and using alcohol (odds ratio, 2.30; 95% CI, 1.26-4.20; p = 0.006) were associated with a doubling in risk of reporting burnout. The use of particular coping strategies was systematically associated with symptoms of burnout and work-related posttraumatic stress in this group of intensive care staff, even after controlling for resilience and other factors. More research on how best to promote adaptive coping is needed in these challenging settings.
Havermans, B.M.; Boot, C.R.L.; Houtman, I.L.D.; Brouwers, E.P.M.; Anema, J.R.; van der Beek, A.J.
Abstract Background Health care workers are exposed to psychosocial work factors. Autonomy and social support are psychosocial work factors that are related to stress, and are argued to largely result from the psychosocial safety climate within organisations. This study aimed to assess to what extent the relation between psychosocial safety climate and stress in health care workers can be explained by autonomy and social support. Methods In a cross-sectional study, psychosocial safety climate...
Hartgerink, Jacqueline; Cramm, Jane; Bakker, Ton; Eijsden, A.; Mackenbach, Johan; Nieboer, Anna
textabstractAim: To identify predictors of relational coordination among professionals delivering care to older patients. Background: Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design: This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. Methods: This study was performed in sp...
J.M. Hartgerink; J.M. Cramm; T.J.E.M. Bakker; A.M. van Eijsden; J.P. Mackenbach; A.P. Nieboer
Aim To identify predictors of relational coordination among professionals delivering care to older patients. Background Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. Methods This study was performed in spring 2010 among ...
Navne, Laura E; Svendsen, Mette N; Gammeltoft, Tine M
In this article, we explore how parents establish relations with extremely premature infants whose lives and futures are uncertain. Drawing on ethnographic fieldwork in a Danish Neonatal Intensive Care Unit (NICU), we engage recent discussions of the limits of conventional anthropological thinking on social relations and point to the productive aspects of practices of distance and detachment. We show that while the NICU upholds an imperative of attachment independently of the infant's chances of survival, for parents, attachment is contingent on certain hesitations in relation to their infant. We argue that there are nuances in practices of relationmaking in need of more attention (i.e., the nexus of attachment and detachment). Refraining from touching, holding, and feeding their infants during critical periods, the parents enact detachment as integral to their practices of attachment. Such "cuts" in parent-infant relations become steps on the way to securing the infant's survival and making kin(ship). We conclude that although infants may be articulated as "maybe-lives" by staff, in the NICU as well as in Danish society, the ideal of attachment appears to leave little room for "maybe-parents." © 2017 by the American Anthropological Association.
Lieshout, J. van; Frigola Capell, E.; Ludt, S.; Grol, R.P.T.M.; Wensing, M.J.P.
OBJECTIVES: Cardiovascular risk management (CVRM) received by patients shows large variation across countries. In this study we explored the aspects of primary care organisation associated with key components of CVRM in coronary heart disease (CHD) patients. DESIGN: Observational study. SETTING: 273
Power, Thomas J.; Michel, Jeremy; Mayne, Stephanie; Miller, Jeffrey; Blum, Nathan J.; Grundmeier, Robert W.; Guevara, James P.; Fiks, Alexander G.
Perhaps the two principal venues for the delivery of mental health services are schools and primary care practices. Unfortunately, these systems of care are poorly connected, which may result in care that is fragmented and suboptimal. This article describes the development and implementation of an electronic health record portal, known as the ADHD…
Providing optimal care for the increasing number of frail older people with complex care needs is a major challenge in primary care. The current approach is reactive and does not meet the needs of older patients, resulting in unnecessary loss of daily functioning, suboptimal quality of life and high
Lewis, Joanne M; DiGiacomo, Michelle; Currow, David C; Davidson, Patricia M
Lower socioeconomic populations live and die in contexts that render them vulnerable to poorer health and wellbeing. Contexts of care at the end of life are overwhelmingly determined by the capacity and nature of formal and informal networks and relations to support care. To date, studies exploring the nature of networks and relations of support in lower socioeconomic populations at the end of life are absent. This qualitative study sought to identify the nature of individual, community and civic networks and relations that defined the contexts of care for this group. Semi-structured qualitative interviews were conducted with 16 patients and 6 informal carers who identified that they had social and economic needs and were from a lower socioeconomic area. A social capital questionnaire identifying individual, community and civic networks and relations formed the interview guide. Interviews were audio-taped, transcribed and analysed using framework analysis. Participants identified that individual and community networks and relations of support were mainly inadequate to meet care needs. Specifically, data revealed: (1) individual (informal caregivers) networks and relations were small and fragile due to the nature of conflict and crisis; (2) community trust and engagement was limited and shifted by illness and caregiving; (3) and formal care services were inconsistent and provided limited practical support. Some transitions in community relations for support were noted. Levels of civic and government engagement and support were overall positive and enabled access to welfare resources. Networks and relations of support are essential for ensuring quality end of life care is achieved. Lower socioeconomic groups are at a distinct disadvantage where these networks and relations are limited, as they lack the resources necessary to augment these gaps. Understanding of the nature of assets and limitations, in networks and relations of support, is necessary to inform
Conlon, Niamh P
OBJECTIVE: To investigate the long-term health-related quality of life (HRQOL) outcomes for patients requiring at least 28 days of pediatric intensive care. DESIGN: Retrospective cohort and prospective follow-up study. SETTING: A 21-bed pediatric intensive care unit (PICU) in a university-affiliated, tertiary referral pediatric hospital. PATIENTS: One hundred ninety-three patients who spent 28 days or longer in the PICU between January 1, 1997 and December 31, 2004. INTERVENTIONS: Quality of life was measured using the Pediatric Quality of Life Inventory (Peds QL 4.0) parent-proxy version at 2 to 10 yrs after discharge. The PedsQL 4.0 is a modular measure of HRQOL, which is reliable in children aged 2 to 18 yrs. It generates a total score and physical, emotional, social, school, and psychosocial subscores. MEASUREMENTS AND MAIN RESULTS: Of the 193 patients, 41 died during their PICU admission and 27 died between PICU discharge and follow-up. Quality of life questionnaires were posted to parents of 108 of the 125 survivors and 70 were returned completed. Forty children (57.1%) had scores indicating a normal quality of life, whereas 30 (42.9%) had scores indicating impaired HRQOL. Of these, 14 (20%) had scores indicating poor quality of life with ongoing disabling health problems requiring hospitalization or the equivalent. CONCLUSIONS: Our results indicate that, while long PICU stay is associated with significant mortality, the long-term HRQOL is normal for the majority of surviving children.
Pracht, Etienne E; Orban, Barbara L; Comins, Meg M; Large, John T; Asin-Oostburg, Virginia
Avoidable hospitalizations represent a key indicator for access to, and the quality of, primary care. Therefore, understanding their behavior is essential in terms of management of healthcare resources and costs. This analysis examines the affect of 2 healthcare strategies on the rate of avoidable hospitalization, managed care and the healthcare safety net. The avoidable hospitalizations definition developed by Weissman et al. (1992) was used to identify relevant inpatient episodes. A 2-stage simultaneous equations multivariate regression model with instrumental variables was used to estimate the relative influence of HMO penetration and the composition of local hospital markets on the rate of avoidable hospitalizations. Control variables in the model include healthcare supply and demand, demographic, socioeconomic, and health status characteristics. Increased market presence of public hospitals significantly reduced avoidable hospitalizations. HMO penetration did not influence the rate of avoidable hospitalizations. The results suggest that public investments in healthcare facilities and infrastructure are more effective in reducing avoidable hospitalizations. © 2011 National Association for Healthcare Quality.
Larbi, Alfred A; Spielberg, Freya; Kamanu Elias, Nnemdi; Athey, Erin; Ogbuawa, Ngozi; Murphy, Nancy
People living with HIV can experience the full benefits of retention when they are continuously engaged in care. Continuous engagement in care promotes improved adherence to ART and positive health outcomes. An infectious disease clinic has implemented a protocol to primarily improve patient retention. The retrospective, facility-based, costing study took place in an infectious disease clinic in Washington DC. Retention was defined in two ways and over a 12-month period. Micro-costing direct measurement methods were used to collect unit costs in time series. Return on investment accounted for the cost of treatment based on CD4 strata. ROI was expressed in 2016USD. The difference in CD4 and viral load levels between the two periods of analysis were determined for active patients, infected with HIV. The year before the intervention was compared to the year of the intervention. Total treatment expenditure decreased from $2,435,653.00 to $2,283,296.23, resulting in a $152,356.77 gain from investment for the healthcare system over a 12-month investment period. The viral load suppression rate increased from 81 to 95 (p = 0.04) over the investment period. The number of patients in need of HIV related opportunistic infection prophylaxis decreased from 21 to 13 (p = 0.06). Improved immunologic, virologic and healthcare expenditure outcomes can be linked to the quality of retention practice.
Lee, Victoria; Guthrie, Else; Robinson, Andrew; Kennedy, Anne; Tomenson, Barbara; Rogers, Anne; Thompson, David
The role of psychological factors in irritable bowel syndrome (IBS) remains unclear, particularly in a primary care setting, where relatively little research on this common and costly condition has been carried out. The aim of this study was to investigate the relative contribution of physical and psychological factors to health-related quality of life and health-care utilization in patients with functional bowel disease (IBS-like symptoms) in primary care. We also wished to establish the relevance of formal diagnostic criteria to IBS in the primary care setting. This study used a cross-sectional design. Four hundred twenty patients with functional bowel disorders in primary care completed a series of measures, including bowel symptom status and severity, severity of psychological distress, personality, and quality of life. The number of visits to a general practitioner (GP) in the previous 12 months was recorded. The following variables were independently and highly significantly associated with health-related quality of life in patients with functional bowel disorders in primary care: total psychological symptom score, diarrhea severity, abdominal pain for >12 weeks, and abdominal distension. A similar pattern emerged between patients who met meet Rome II criteria for IBS and patients who did not meet Rome II criteria for IBS. Relatively few variables (either physical or psychological) had a major impact on the number of GP consultations, with the exception of frequency of bowel movements. This study confirms that psychological factors are significantly associated with health-related quality of life in patients with IBS in primary care. Physical symptom severity is also important. Relatively few symptom measures, either physical or psychological, have a major impact on doctor consultation rates in primary care.
Sørensen, Lin; Sonuga-Barke, Edmund; Eichele, Heike; van Wageningen, Heidi; Wollschlaeger, Daniel; Plessen, Kerstin Jessica
Suboptimal decision making in the face of risk (DMR) in children with attention-deficit hyperactivity disorder (ADHD) may be mediated by deficits in a number of different neuropsychological processes. We investigated DMR in children with ADHD using the Cambridge Gambling Task (CGT) to distinguish difficulties in adjusting to changing probabilities of choice outcomes (so-called risk adjustment) from general risk proneness, and to distinguish these 2 processes from delay aversion (the tendency to choose the least delayed option) and impairments in the ability to reflect on choice options. Based on previous research, we predicted that suboptimal performance on this task in children with ADHD would be primarily relate to problems with risk adjustment and delay aversion rather than general risk proneness. Drug naïve children with ADHD (n = 36), 8 to 12 years, and an age-matched group of typically developing children (n = 34) performed the CGT. As predicted, children with ADHD were not more prone to making risky choices (i.e., risk proneness). However, they had difficulty adjusting to changing risk levels and were more delay aversive-with these 2 effects being correlated. Our findings add to the growing body of evidence that children with ADHD do not favor risk taking per se when performing gambling tasks, but rather may lack the cognitive skills or motivational style to appraise changing patterns of risk effectively. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Martin, Summer C
The ways in which Parkinson's disease (PD) impacts, and is experienced by, the couple (i.e., the individual with PD and his or her spouse or other romantic partner) have not been fully elucidated. Such research is strongly warranted because when one member of a couple is chronically ill, it can cause major distress for not only the patient but also for his or her partner and their relationship. Therefore, the goal of this study was to examine how PD affects a couple's relationship. Data from 44 individual, in-depth interviews (with 21 persons with PD and 23 partners) revealed several challenges that PD commonly invokes in the patient-partner relationship, though most participants reported that PD had not decreased their overall relational closeness. The findings have significant practical implications for family-focused care. © The Author(s) 2016.
Olga Lidia Casillas-Cárdenas
Full Text Available Today, society faces the secondary traumatic stress in work settings, transmitted through the intervention process the social worker, serving human social suffering of the families. This phenomenon is reflected as burnout or contagion of emotions similar to those suffered by subjects treated, characterized by pain, anguish and fear behaviors, and is associated with the cost of care. The purpose of this paper is to reflect on the emergence of relationships that emerge in the process of social intervention, as simultaneous complex relationships that keep reciprocity between the life of the social worker, the suffering of the treated subject and labor dynamics, where a frame is shared favoring meanings recirculation secondary traumatic stress. Previous advances show complex triadic relations, which only have interconnection through professional speaking at a given time and space.
Luth, Elizabeth A; Prigerson, Holly G
Non-Hispanic black and dementia patients receive more invasive and futile treatment at end of life (EOL) relative to others. Little is known about the relationship between race/ethnicity, dementia, and EOL care quality. Identify the relationship between race/ethnicity, dementia, and proxy reporters' evaluation of EOL care quality in older adults. Latent class analysis (LCA) of national survey data. 1588 deceased Medicare beneficiaries age 65 and older from the National Health and Aging Trends Study (2011-2016). LCA identified three types of quality EOL care using nine measures of symptom management, quality of healthcare encounters, and dignified treatment. Race and dementia were primary predictors of EOL care quality type. Adjusted models controlled for decedent education, sex, marital status, age, number of illnesses, number of hospitalizations, self-rated health, place of death, hospice involvement, and proxy relationship to decedent and familiarity with care. Over 20% of proxies report that dying individuals experienced suboptimal EOL care quality, characterized by pain, sadness, poor communication, and inattention to personal care needs. In adjusted analyses, proxies for non-Hispanic black decedents were less likely to provide negative care assessments than proxies for non-Hispanic white decedents (adjusted odds ratio [AOR]: 0.58; 95% confidence interval [CI]: 0.40-0.86). Proxies for decedents with dementia were less likely to provide negative assessments than proxies for decedents without dementia (AOR: 0.70; 95% CI: 0.51-0.97). Efforts to improve EOL care quality are needed. More positive EOL care quality assessments for non-Hispanic Black and dementia decedents appear counterintuitive given research demonstrating that these groups of individuals are likely to have received suboptimal EOL care. Because caregiver expectations for care may differ by decedent race and dementia status, research is needed to explore the role of caregiver expectations for EOL care
Martín Delgado, M C; Merino de Cos, P; Sirgo Rodríguez, G; Álvarez Rodríguez, J; Gutiérrez Cía, I; Obón Azuara, B; Alonso Ovies, Á
To explore contributing factors (CF) associated to related critical patients safety incidents. SYREC study pos hoc analysis. A total of 79 Intensive Care Departments were involved. The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even thought CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.
Full Text Available Abstract Background Inpatient care for alcohol intoxication is increasing in Sweden, especially among young women. Since it is well known that alcohol disorder is a chronic relapsing illness, this study examines the extent to which people return for more care. Method All inpatients with alcohol-related diagnoses in Stockholm County during 1997 were followed prospectively to 2007 through registers. The proportion reappearing for the same diagnosis, other alcohol-related inpatient, or outpatient care each year after baseline, as well as the number of years the inpatients reappeared were calculated (n = 2735. Three diagnoses were examined separately; alcohol dependence, harmful use of alcohol, and alcohol intoxication. Results Three out of five inpatients with an alcohol diagnoses reappeared for more alcohol-related inpatient care during the following decade. The proportion returning was largest the year after baseline and then decreased curvilinearly over time. The inclusion of outpatient care increased proportions, but did not change patterns. Of those with an alcohol dependence diagnosis at baseline 42 percent returned for more alcohol-related inpatient care the first, 28 percent the fifth, and 25 percent the tenth year. Corresponding proportions for harmful use and intoxication were smaller. One in five among those with an alcohol dependence returned for more than five of the ten years. Ordered logistic regressions confirmed that besides diagnosis, age and gender were independently related to the number of years returning to care. Conclusions While middle-aged males with alcohol dependence were in a revolving door, young female inpatients with intoxication diagnosis returned to a comparably lower degree.
Adsersen, Mathilde; Thygesen, Lau Caspar; Jensen, Anders Bonde
BACKGROUND: Specialised palliative care (SPC) takes place in specialised services for patients with complex symptoms and problems. Little is known about what determines the admission of patients to SPC and whether there are differences in relation to institution type. The aims of the study were t...
Chavez, Laura J; Grannis, Connor; Dolce, Millie; Chisolm, Deena J
Caring for teens with special health care needs places physical and mental health burdens on parents, which can be exacerbated by the stresses of transitions to independence. Medical homes can improve teen transitions to greater self-management and reduce health care-related time and financial burdens for families. We examined the association between parent-reported teen medical home status and caregiver health-related quality of life (HRQOL). The study sample included parents or caregivers of teens with special health care needs aged 15 to 18 recruited from a pediatric Medicaid accountable care organization who participated in a survey (response rate, 40.5%). The primary outcome was parent HRQOL scores (0-100 points) measured using the Pediatric Quality of Life Inventory Family Impact Module. Medical home status was based on parent report of teen's health care meeting medical home criteria. Linear regression models were used to estimate HRQOL scores, adjusted for demographic characteristics, health literacy, and teen functional limitation. Among 488 parents, 27% reported their teen received care consistent with a medical home. Adjusted parent HRQOL scores were significantly higher among those whose teens had a medical home (74.40; 95% confidence interval, 71.31-77.48), relative to those whose teens did not (65.78; 95% confidence interval, 63.92-67.65). Medical home subscale analyses showed HRQOL scores had significant positive associations with family-centered care and coordinated care, but not other subscales. Teen medical home status was positively associated with caregiver HRQOL, suggesting that the medical home may benefit overall caregiver well-being. In particular, receiving care that was family centered and coordinated appeared to be the most beneficial. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Gary Burtless; Pavel Svaton
Cash income offers an incomplete picture of the resources available to finance household consumption. Most American families are covered by an insurance plan that pays for some or all of the health care they consume. Only a comparatively small percentage of families pay for the full cost of this insurance out of their cash incomes. As health care has claimed a growing share of consumption, the percentage of care that is financed out of household incomes has declined. Because health care consu...
Tandon, Pooja S; Zhou, Chuan; Christakis, Dimitri A
Given that more than 34% of U.S. children are cared for in home-based child care settings and outdoor play is associated with physical activity and other health benefits, we sought to characterize the outdoor play frequency of preschoolers cared for at home-based child care settings and factors associated with outdoor play. Cross-sectional study of 1900 preschoolers (representing approximately 862,800 children) cared for in home-based child care settings (including relative and nonrelative care) using the nationally representative Early Childhood Longitudinal Study, Birth Cohort. Only 50% of home-based child care providers reported taking the child outside to walk or play at least once/day. More than one-third of all children did not go outside to play daily with either their parent(s) or home-based child care provider. There were increased odds of going outside daily for children cared for by nonrelatives in the child's home compared with care from a relative. Children with ≥3 regular playmates had greater odds of being taken outdoors by either the parents or child care provider. We did not find statistically significant associations between other child level (age, sex, screen-time), family level (highest education in household, mother's race, employment, exercise frequency), and child care level (hours in care, provider's educational attainment, perception of neighborhood safety) factors and frequency of outdoor play. At a national level, the frequency of outdoor play for preschoolers cared for in home-based child care settings is suboptimal. Further study and efforts to increase outdoor playtime for children in home-based child care settings are needed. Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Heide, I. van der; Heijmans, M.; Schuit, A.J.; Uiters, E.; Rademakers, J.
Introduction: In chronic care, patients are expected to exert a certain degree of control over the care for their condition, for instance by fulfilling care tasks in their home environment. Health literacy is considered relevant in this regard, especially critical health literacy. The aim of this
Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Bosch, W.J.H.M. van den
BACKGROUND: The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. OBJECTIVE: In order to clarify the confusion of
Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; van den Bosch, W.J.H.M.
Background: The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. Objective: In order to clarify the confusion of
Eltaybani, Sameh; Noguchi-Watanabe, Maiko; Igarashi, Ayumi; Saito, Yumiko; Yamamoto-Mitani, Noriko
Keeping long-term care nurses employed is necessary to sustain the current and future demand for high-quality long-term care services. Understanding the factors relating to intention to stay among long-term care nurses is limited by the scarcity of studies in long-term care settings, lack of investigation of multiple factors, and the weakness of existing explanatory models. To identify the factors associated with long-term care nurses' intention to stay in their current workplace. A cross-sectional questionnaire survey. Two hundred and fifty-seven hospitals with long-term care wards across Japan. A total of 3128 staff nurses and 257 nurse managers from the long-term care wards of the participating hospitals. The questionnaire assessed nurses' intention to continue working in the current workplace as well as potential related factors, including individual factors (demographic data, reason for choosing current workplace, burnout, work engagement, somatic symptom burden) and unit factors (unit size, nurse-manager-related data, patients' medical acuity, average number of overtime hours, recreational activities, social support, perceived quality of care process, educational opportunities, feeling of loneliness, and ability to request days off). Multilevel logistic regression analysis was used to determine which variables best explained nurses' intention to stay in their workplace. Only 40.1% of the respondents reported wanting to continue working at their current workplace. The regression analysis revealed that long-term care nurses' intention to stay was positively associated with nurses' age (odds ratio [95% confidence interval]: 1.02 [1.01-1.03]), work engagement (1.24 [1.14-1.35]), getting appropriate support from nurse managers (2.78 [1.60-4.82]), perceived quality of care process (1.04 [1.01-1.06]), educational opportunities (1.06 [1.0-1.13]), and various specific reasons for choosing their workplace (e.g., a good workplace atmosphere, being interested in
Vogl, Matthias; Schildmann, Eva; Leidl, Reiner; Hodiamont, Farina; Kalies, Helen; Maier, Bernd Oliver; Schlemmer, Marcus; Roller, Susanne; Bausewein, Claudia
Hospital costs and cost drivers in palliative care are poorly analysed. It remains unknown whether current German Diagnosis-Related Groups, mainly relying on main diagnosis or procedure, reproduce costs adequately. The aim of this study was therefore to analyse costs and reimbursement for inpatient palliative care and to identify relevant cost drivers. Two-center, standardised micro-costing approach with patient-level cost calculations and analysis of the reimbursement situation for patients receiving palliative care at two German hospitals (7/2012-12/2013). Data were analysed for the total group receiving hospital care covering, but not exclusively, palliative care (group A) and the subgroup receiving palliative care only (group B). Patient and care characteristics predictive of inpatient costs of palliative care were derived by generalised linear models and investigated by classification and regression tree analysis. Between 7/2012 and 12/2013, 2151 patients received care in the two hospitals including, but not exclusively, on the PCUs (group A). In 2013, 784 patients received care on the two PCUs only (group B). Mean total costs per case were € 7392 (SD 7897) (group A) and € 5763 (SD 3664) (group B), mean total reimbursement per case € 5155 (SD 6347) (group A) and € 4278 (SD 2194) (group B). For group A/B on the ward, 58%/67% of the overall costs and 48%/53%, 65%/82% and 64%/72% of costs for nursing, physicians and infrastructure were reimbursed, respectively. Main diagnosis did not significantly influence costs. However, duration of palliative care and total length of stay were (related to the cost calculation method) identified as significant cost drivers. Related to the cost calculation method, total length of stay and duration of palliative care were identified as significant cost drivers. In contrast, main diagnosis did not reflect costs. In addition, results show that reimbursement within the German Diagnosis-Related Groups system does not
Osuji, Peter I
The perspectives of the dominant Western ethical theories, have dominated the concepts of autonomy and informed consent for many years. Recently this dominant understanding has been challenged by ethics of care which, although, also emanates from the West presents a more nuanced concept: relational autonomy, which is more faithful to our human experience. By paying particular attention to relational autonomy, particularity and Process approach to ethical deliberations in ethics of care, this paper seeks to construct a concept of informed consent from the perspective of ethics of care which is here called relational autonomy-in-informed consent (RAIC). Thus, providing a broader theoretical basis for informed consent beyond the usual theoretical perspectives that are particularly Western. Care ethics provides such a broader basis because it appeals to a global perspective that encompasses lessons from other cultures, and this will help to enrich the current ideas of bioethics principles of autonomy and informed consent. This objective will be achieved by exploring the ethics of care emphasis on relationships based on a universal experience of caring; and by contrasting its concept of autonomy as relational with the understanding of autonomy in the approaches of the dominant moral theories that reflect rational, individualistic, and rights-oriented autonomy of the American liberalism.
Ewers, Michael; Schaepe, Christiane; Lehmann, Yvonne
Background: The number of home mechanically ventilated (HMV) patients has been growing for years. However, little is known about requirements, processes and effects of advanced home care, provided in distance from clinics and doctors. To date, safety related aspects of the above mentioned issues have scarcely been examined. Aim: Users of advanced home care were asked about their experiences and about situations in which they felt safe or unsafe. The aim was to gain insights into the daily care provision, explore safety risks from the users’ point of view, and to develop new approaches to enhance patient safety in home care for the severely ill. Method: A qualitative explorative study has been carried out, based on semi-structured interviews (ventilated patients N = 21; relatives N = 15). Sampling, data collecting and data analysis were guided by principles of Grounded Theory. Results: Risk situations occur when (non-)verbal communication offers of HMV patients are overseen or misunderstood, patient- or technology related monitoring tasks are neglected, if coordination and collaboration requirements are undervalued and if negotiation processes as well as education and supervision needs are disregarded. Furthermore, nurses’ lack of competence, self-confidence and professionalism may produce risk situations. Conclusion: Listen carefully to patients and relatives can help to identify quality shortcomings in advanced home care, to prevent risk situations and to develop patient-centered safety concepts for this particular setting.
Svenningsen, Helle; Tønnesen, Else K; Videbech, Poul
after intensive care unit. Interviews were repeated after two and six months and supplemented with Short Form-36 and the Barthel Index. RESULTS: Delirium was detected in 60% of the patients in our study, and delirious patients had significantly fewer factual memories and more memories of delusion than...... than half of the patients in intensive care unit experience delirium, which is associated with fewer factual memories and more memories of delusions. Short Form-36 might not be sensitive to delirium-related outcomes. Future research should include the development of better assessment tools to determine...... the long-term consequences of intensive care unit delirium. RELEVANCE TO CLINICAL PRACTICE: We recommend regular assessment to prevent, detect and treat delirium. We also recommend an intensive care unit follow-up programme providing an opportunity for postintensive care unit patients, particularly...
Egashira, Kazuhiro; Sumita, Yoshinori; Zhong, Weijian; I, Takashi; Ohba, Seigo; Nagai, Kazuhiro; Asahina, Izumi
Bone marrow concentrate (BMC), which is enriched in mononuclear cells (MNCs) and platelets, has recently attracted the attention of clinicians as a new optional means for bone engineering. We previously reported that the osteoinductive effect of bone morphogenetic protein-2 (BMP-2) could be enhanced synergistically by co-transplantation of peripheral blood (PB)-derived platelet-rich plasma (PRP). This study aims to investigate whether BMC can effectively promote bone formation induced by low-dose BMP-2, thereby reducing the undesirable side-effects of BMP-2, compared to PRP. Human BMC was obtained from bone marrow aspirates using an automated blood separator. The BMC was then seeded onto β-TCP granules pre-adsorbed with a suboptimal-dose (minimum concentration to induce bone formation at 2 weeks in mice) of recombinant human (rh) BMP-2. These specimens were transplanted subcutaneously to the dorsal skin of immunodeficient-mice and the induction of ectopic bone formation was assessed 2 and 4 weeks post-transplantation. Transplantations of five other groups [PB, PRP, platelet-poor plasma (PPP), bone marrow aspirate (BM), and BM-PPP] were employed as experimental controls. Then, to clarify the effects on vertical bone augmentation, specimens from the six groups were transplanted for on-lay placement on the craniums of mice. The results indicated that BMC, which contained an approximately 2.5-fold increase in the number of MNCs compared to PRP, could accelerate ectopic bone formation until 2 weeks post-transplantation. On the cranium, the BMC group promoted bone augmentation with a suboptimal-dose of rhBMP-2 compared to other groups. Particularly in the BMC specimens harvested at 4 weeks, we observed newly formed bone surrounding the TCP granules at sites far from the calvarial bone. In conclusion, the addition of BMC could reduce the amount of rhBMP-2 by one-half via its synergistic effect on early-phase osteoinduction. We propose here that BMC transplantation
Conclusion: This study showed that the overall perceived performance is higher than expectation for home health care service provided. The primary caregiver who was older than 30 years, who had lower education level, and other than siblings showed higher satisfaction. The four items that need improving included “home health care nurses will provide detailed description of services,” “home health care nurses will provide knowledge of illness,” “home health care nurses can complete the promised tasks,” and “home health care nurses will actively inquire patient’s conditions and needs.”
Couderc, C; Carbonne, A; Thiolet, J M; Brossier, F; Savey, A; Bernet, C; Ortmans, C; Lecadet-Morin, C; Coudière, I; Aggoune, M; Astagneau, P; Coignard, B; Cambau, E
Non-tuberculous mycobacteria (NTM) infections usually occur in immunocompromised patients but also in immunocompetent patients following invasive procedures, especially for esthetic purposes. Since 2001, 20 episodes (57 cases) of NTM infections, seven of which (43 cases) were related to esthetic care, have been reported to the regional infection control coordinating centers (RICCC), the local health authorities (LHA), and the national institute for public health surveillance. Four notifications (40 cases) were related to non-surgical procedures performed by general practitioners in private settings: mesotherapy, carboxytherapy, and sclerosis of microvaricosities. The three other notifications (three cases) concerned surgical procedures-lifting and mammary prosthesis. Practice evaluations performed by the RICCC and LHA for five notifications showed deficiency of standard hygiene precautions and tap water misuse for injection equipment cleaning, or skin disinfection. Microbiological investigations (national reference center for mycobacteria) demonstrated the similarity of patient and environmental strains: in one episode (16 cases after mesotherapy), M. chelonae isolated from tap water was similar to those isolated from 11 cases. Healthcare-associated NTM infections are rare but have a potentially severe outcome. These cases stress the need of healthcare-associated infection notifications in outpatient settings. Copyright © 2011 Elsevier Masson SAS. All rights reserved.
Iedema, Rick; Allen, Suellen; Britton, Katherine; Gallagher, Thomas H
To understand what patients and family members know about problems and failures in healthcare. Qualitative, semistructured open-ended interviews were conducted with 39 patients and 80 family members about their experiences of incidents in tertiary healthcare. Nineteen interviews involved more than one respondent, yielding 100 interviews in total. Participants were recruited through advertisements in the national broadsheet and tabloid print media (43%), with the help of the health services where the incidents occurred (28%), through invitations sent out by two internet marketing companies (27%) and by consumer organisations (2%). Interviews were conducted in the homes of the respondents or over the phone. One participant emailed her responses to the questionnaire. Analysis of the interview data revealed: (1) considerable knowledge on the part of patients and relatives about health service risks, problems and incidents; (2) the insight of interviewees into care improvement opportunities; and (3) challenges faced by patients and relatives when trying to negotiate their knowledge and insights with health service staff. Patients (and family members) need access to structured processes ensuring dialogue with health service personnel about perceived risks, problems and incidents. Such dialogue would reveal patients' and family members' questions and knowledge about improvement opportunities, and minimise the risk that their questions and knowledge are ignored.
Kabir, Mohammad Javad; Heidari, Alireza; Etemad, Koorosh; Gashti, Ashrafi Babazadeh; Jafari, Nahid; Honarvar, Mohammad Reza; Ariaee, Mohammad; Lotfi, Mansureh
Burnout causes physical and emotional tireness, job dissatisfaction, resulting in reduced efficiency and a feeling of alienation from colleagues. Also, job satisfaction has a major impact on job-related behaviors, such as turnover intention, absenteeism, and job performance. The aim of this study was to determine job burnout, job satisfaction rate, and related factors among health care workers in Golestan Province in Iran. This cross-sectional study was conducted with 1,141 health workers in Golestan Province in northern Iran. Data were collected using a questionnaire that was comprised of four sections. It consisted of socio-economic characteristics, physical environment and facilities of health house (rural health clinic), Maslach burnout inventory, and a satisfaction questionnaire. Multi-nomial Logistic Regression was conducted to analyze the data using SPSS software, version 22. There were significant relationships between the intensity of job burnout and age (p income (p job burnout and age (p income (p job satisfaction and the satisfaction from income (p = 0.001), the physical environment of health houses (p = 0.001), and the facilities of health houses (p = 0.001). Burnout was average among health workers, and health workers job satisfaction rate was lower than the average level in health workers. Effective interventions are recommended with regards to the unfavorable condition of job satisfaction and its relationship with job burnout.
Campbell, David J T; King-Shier, Kathryn; Hemmelgarn, Brenda R; Sanmartin, Claudia; Ronksley, Paul E; Weaver, Robert G; Tonelli, Marcello; Hennessy, Deirdre; Manns, Braden J
People with chronic conditions who do not achieve therapeutic targets have a higher risk of adverse health outcomes. Failure to meet these targets may be due to a variety of barriers. This article examines self-reported financial barriers to health care among people with cardiovascular-related chronic conditions. A population-based survey was administered to western Canadians with cardiovascular-related chronic conditions (n = 1,849). Associations between self-reported financial barriers and statin use, the likelihood of stopping use of prescribed medications, and emergency department visits or hospitalizations were assessed. More than 10% respondents reported general financial barriers (12%) and lack of drug insurance (14%); 4% reported financial barriers to accessing medications. Emergency department visits or hospitalizations were 70% more likely among those reporting a general financial barrier. Those reporting a financial barrier to medications were 50% less likely to take statins and three times more likely to stop using prescribed medications. Individuals without drug insurance were nearly 30% less likely to take statins. In this population, self-reported financial barriers were associated with lower medication use and increased likelihood of emergency department visits or hospitalization.
Klug, Hope; Bonsall, Michael B; Alonzo, Suzanne H
The evolution of maternal, paternal, and bi-parental care has been the focus of a great deal of research. Males and females vary in basic life-history characteristics (e.g., stage-specific mortality, maturation) in ways that are unrelated to parental investment. Surprisingly, few studies have examined the effect of this variation in male and female life history on the evolution of care. Here, we use a theoretical approach to determine the sex-specific life-history characteristics that give rise to the origin of paternal, maternal, or bi-parental care from an ancestral state of no care. Females initially invest more into each egg than males. Despite this inherent difference between the sexes, paternal, maternal, and bi-parental care are equally likely when males and females are otherwise similar. Thus, sex differences in initial zygotic investment do not explain the origin of one pattern of care over another. However, sex differences in adult mortality, egg maturation rate, and juvenile survival affect the pattern of care that will be most likely to evolve. Maternal care is more likely if female adult mortality is high, whereas paternal care is more likely if male adult mortality is high. These findings suggest that basic life-history differences between the sexes can alone explain the origin of maternal, paternal, and bi-parental care. As a result, the influence of life-history characteristics should be considered as a baseline scenario in studies examining the origin of care.
Walker, N J; Van Woerden, H C; Kiparoglou, V; Yang, Y
As part of an electronic dashboard operated by Public Health Wales, senior managers at hospitals in Wales report daily "escalation" scores which reflect management opinion on the pressure a hospital is experiencing and ability to meet ongoing demand with respect to unscheduled care. An analysis was undertaken of escalation scores returned for 18 hospitals in Wales between the years 2006 and 2014 inclusive, with a view to identifying systematic temporal patterns in pressure experienced by hospitals in relation to unscheduled care. Exploratory data analysis indicated the presence of within-year cyclicity in average daily scores over all hospitals. In order to quantify this cyclicity, a Generalised Linear Mixed Model was fitted which incorporated a trigonometric function (sine and cosine) to capture within-year change in escalation. In addition, a 7-level categorical day of the week effect was fitted as well as a 3-level categorical Christmas holiday variable based on patterns observed in exploration of the raw data. All of the main effects investigated were found to be statistically significant. Firstly, significant differences emerged in terms of overall pressure reported by individual hospitals. Furthermore, escalation scores were found to vary systematically within-year in a wave-like fashion for all hospitals (but not between hospitals) with the period of highest pressure consistently observed to occur in winter and lowest pressure in summer. In addition to this annual variation, pressure reported by hospitals was also found to be influenced by day of the week (low at weekends, high early in the working week) and especially low over the Christmas period but high immediately afterwards. Whilst unpredictable to a degree, quantifiable pressure experienced by hospitals can be anticipated according to models incorporating systematic temporal patterns. In the context of finite resources for healthcare services, these findings could optimise staffing schedules and
Zulu, Joseph M; Ali, Joseph; Hallez, Kristina; Kass, Nancy; Michelo, Charles; Hyder, Adnan A
An increase in post abortion care (PAC) research with adolescents, particularly in low- and middle-income countries, has brought to attention several associated research ethics challenges. In order to better understand the ethics context of PAC research with adolescents, we conducted a scoping review of published literature. Following a systematic search of PubMed, HINARI, and Google Scholar, we analysed articles meeting inclusion criteria to determine common themes across both the ethical challenges related to PAC research with adolescents and any available guidance on the identified challenges. The literature search identified an initial 3321 records of which 14 were included in analysis following screening. Several ethical challenges stem from abortion being a controversial, sensitive, and stigmatized topic in many settings. Ethical dilemmas experienced by researchers conducting adolescent PAC research included: difficulties in convincing local health providers to permit PAC research; challenges in recruiting and seeking consent due to sensitivity of the subject; effectively protecting confidentiality; managing negative effects of interventions; creating a non-prejudicial atmosphere for research; managing emotional issues among adolescents; and dealing with uncertainty regarding the role of researchers when observing unethical health care practices. Suggested strategies for addressing some of these challenges include: using several sources to recruit study participants, using research to facilitate dialogue on abortion, briefing health workers on any observed unethical practices after data collection, fostering a comprehensive understanding of contextual norms and values, selecting staff with experience working with study populations, and avoiding collection of personal identifiers. Addressing ethical challenges that researchers face when conducting PAC research with adolescents requires guidance at the individual, institutional, community, and international
Miqueleiz, Estrella; te Velde, Saskia; Regidor, Enrique; van Lippevelde, Wendy; Vik, Froydis N.; Fernández-Alvira, Juan Miguel; Vicente-Rodríguez, Germán; Kunst, Anton
Background: The prevalence of childhood obesity is higher in Spain than in Northern European countries for reasons that are still unknown. The objective was to determine whether variables related to lifestyle habits and styles of parental care related to obesity in children differ between the
Donker, G.A.; Rijken, P.M.; Korevaar, J.C.; Custers, J.; Hofstede, J.; Francke, A.L.
Background: Cancer causes approximately one third of all deaths in industrialized countries. Hence advanced cancer patients and their relatives are a main target group of palliative care. Methods: In qualitative interviews with 13 Dutch patients and 14 relatives confronted with advanced cancer
Full Text Available The increased role of the sub-optimal land to support food security continue to be encouraged in Indonesia, given the more limited expansion for potential land. But until recently, development of sub-optimal land becomes not an easy thing. Ecological and technical barriers became the main issue. A series of these issues resulted in a high number of underemproleymeny and poverty in agriculture region. Technological inovation of agriculture and the business diversification can be seen be the solution to those issues. This research aims to analyze the impact of the technological innovation and business diversification on underemployment, working time, household income and also sustainable livelihoods of farmers on the sub-optimal land. The research was carried out in Pemulutan District, Ogan Ilir Regency, South Sumatra Province, Indonesia. The objects of research are farmers which adopter and non adopter technological innovation, and also work outside of paddy farming (business diversification. The research method is the survey. Method of sampling is stratified random sampling. Data obtained in the field analyses using descriptive statistics and inferesia. The results showed there are positive impact of technological innovation on the allocation of working time farmer households, the numbers underemployment, household income and livelihood sustainability. Determinant factors for farmers in applying technology and business diversification are paddy farming income, off-farm income, and age. The use of technology and business diversification proves to be one of the positive scenarios for sustainable livelihood of farmers in sub-optimal land.
Zandvoort, M.H.; Geerts, R.; Lettinga, G.; Lens, P.N.L.
The effect of sub-optimal trace metal concentrations on the conversion of methanol in an upflow anaerobic sludge bed (UASB) reactor was investigated by studying the effect of decreased influent trace metal concentrations on the reactor efficiency, methanol conversion route and sludge
Siefried, Krista J; Mao, Limin; Kerr, Stephen; Cysique, Lucette A; Gates, Thomas M; McAllister, John; Maynard, Anthony; de Wit, John; Carr, Andrew
BACKGROUND: Missing more than one tablet of contemporary antiretroviral therapy (ART) per month increases the risk of virological failure. Recent studies evaluating a comprehensive range of potential risk factors for suboptimal adherence are not available for high-income settings. METHODS: Adults on
Jover-Sancho, C; Romero-García, M; Delgado-Hito, P; de la Cueva-Ariza, L; Solà-Solé, N; Acosta-Mejuto, B; Ricart-Basagaña, M T; Solà-Ribó, M; Juandó-Prats, C L
Explore convergences and divergences between perception of nurses and of critically ill patients, in relation to the satisfactory care given and received. It is part of a larger qualitative study, according to the Grounded Theory. Carried out in 3 intensive care units with 34 boxes. Sampling theoretical profiles with n=19 patients and n=7 nurses after data saturation. Recruitment of patients included in the profiles of elderly and long-stay got stretched over some time due to the low incidence of cases. Data collection consisted of: in-depth interview to critically ill patients, group discussion of expert nurses in the critical care patient and field diary. Analysis themed on Grounded Theory according Strauss and Corbin: open coding, axial and selective. Analysis followed criteria of Guba and Lincoln rigor, Calderón quality and Gastaldo and McKeever ethical reflexivity. There was a favorable report from the ethical committee of the Hospital and informed consent of the participants. Four matching categories were found: professional skills, human, technical and continued care. Combination of these elements creates feelings of security, calmness and feeling like a person, allowing the patient a close and trusting relationship with the nurse who takes individualized care. Not divergent categories were found. Perceptions of nurses in relation to care match perceptions of critically ill patients in both the definition and dimensions upon satisfactory care. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
(HIV viral load <400 copies/mL. Multivariate logistic regression analysis was performed to identify independent predictors of ART non-adherence. Results: The overall median (interquartile range ART adherence was 99% (96.5–100 (N = 82. Seventy-six percent of adolescents had excellent pill count ART adherence levels and 94% achieved virologic suppression. Male adolescents made up 65% of the non-adherent group (P = 0.02. Those who displayed suboptimal ART adherence were more likely to report having ever missed ART doses due to failure to pick up medication at the pharmacy (30.0% versus 9.7%, P = 0.03. In the multivariate logistic regression model, male sex (odds ratio [OR] 3.29, 95% confidence interval [CI] 1.13–9.54; P = 0.03 was the only factor which was independently associated with suboptimal ART adherence. Conclusions: A high proportion of HIV-infected adolescents studied had excellent ART adherence and virologic suppression, with male adolescents at higher risk of suboptimal adherence than females. Further research to investigate how gender relates to suboptimal adherence may aid in the design of targeted intervention strategies. Keywords: HIV/AIDS, ART adherence, adolescents, barriers, Botswana
Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D; van der Heide, Agnes; van der Wal, Gerrit; van der Maas, Paul J
In recent decades significant developments in end-of-life care have taken place in The Netherlands. There has been more attention for palliative care and alongside the practice of euthanasia has been regulated. The aim of this paper is to describe the opinions of physicians with regard to the relationship between palliative care and euthanasia, and determinants of these opinions. Cross-sectional. Representative samples of physicians (n = 410), relatives of patients who died after euthanasia and physician-assisted suicide (EAS; n = 87), and members of the Euthanasia Review Committees (ERCs; n = 35). Structured interviews with physicians and relatives of patients, and a written questionnaire for the members of the ERCs. Approximately half of the physicians disagreed and one third agreed with statements describing the quality of palliative care in The Netherlands as suboptimal and describing the expertise of physicians with regard to palliative care as insufficient. Almost two thirds of the physicians disagreed with the suggestion that adequate treatment of pain and terminal care make euthanasia redundant. Having a religious belief, being a nursing home physician or a clinical specialist, never having performed euthanasia, and not wanting to perform euthanasia were related to the belief that adequate treatment of pain and terminal care could make euthanasia redundant. The study results indicate that most physicians in The Netherlands are not convinced that palliative care can always alleviate all suffering at the end of life and believe that euthanasia could be appropriate in some cases.
Winocour, P H; Morgan, J; Ainsworth, A; Williams, D R R
To examine the provision of, and variations in, podiatry and other services for diabetic foot care in the UK. A postal survey of secondary care providers of diabetes services in the UK in 2000. Following two reminders a 77% response rate was achieved. The responses indicated that 97% had a state-registered podiatrist attached to the service, providing three (median) sessions each week for diabetes care, although only 44% had availability at all diabetic clinics, and only 3% had availability at paediatric diabetic services. Podiatry access at all diabetic clinics increased the likelihood of associated preventative as opposed to reactive ('trouble shooting') care (P podiatry input to patient education was common (84%), only 6% had received formal training in education. Guidelines and strategies for management of active foot problems were available in 50-74% of cases. Orthotic input was highly variable, and absent in 15% of responses. Podiatrist fitting and application of foot protective apparatus was only recorded in 22-61% of responses. Access to isotopic and/or MR foot imaging and peripheral angiography and angioplasty was recorded in 75-83% of responses. Separate specialist foot clinics were available in 49%, and where this was the case the use of newer foot ulcer healing applications was higher (P podiatry support to diabetes care over the last 10 years, the level of access and the nature of the services provided is much less than recommended in many advisory documents. The strategy of a co-ordinated 'team' approach to foot care still takes place in less than 50% of centres. There are clear regional differences in diabetes foot care services. Both providers and purchasers of diabetes services may not have given sufficient attention to this area, given the relatively small number of documented bids for service improvements in this area, and the very low success rate of such bids.
Hagenaars, Luc L; Klazinga, Niek S; Mueller, Michael; Morgan, David J; Jeurissen, Patrick P T
Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. We used OECD data, which include health system governance and financing-related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel). We find that governance and financing-related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross-country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single-payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference. These differences can partially be explained because multi-payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems. Copyright © 2017 John Wiley & Sons, Ltd.
Magrath, Priscilla; Nichter, Mark
Over the past decade, the use of financial incentive schemes has become a popular form of intervention to boost performance in the health sector. Often termed "paying for performance" or P4P, they involve "…the transfer of money or material goods conditional upon taking a measurable action or achieving a predetermined performance target" (Eldridge & Palmer, 2009, p.160). P4P appear to bring about rapid improvements in some measured indicators of provider performance, at least over the short term. However, evidence for the impact of these schemes on the wider health system remains limited, and even where evaluations have been positive, unintended effects have been identified. These have included: "gaming" the system; crowding out of "intrinsic motivation"; a drop in morale where schemes are viewed as unfair; and the undermining of social relations and teamwork through competition, envy or ill feeling. Less information is available concerning how these processes occur, and how they vary across social and cultural contexts. While recognizing the potential of P4P, the authors argue for greater care in adapting schemes to particular local contexts. We suggest that insights from social science theory coupled with the focused ethnographic methods of anthropology can contribute to the critical assessment of P4P schemes and to their adaptation to particular social environments and reward systems. We highlight the need for monitoring P4P schemes in relation to worker motivation and the quality of social relations, since these have implications both for health sector performance over the long term and for the success and sustainability of a P4P scheme. Suggestions are made for ethnographies, undertaken in collaboration with local stakeholders, to assess readiness for P4P; package rewards in ways that minimize perverse responses; identify process variables for monitoring and evaluation; and build sustainability into program design through linkage with complementary reforms
Wichmann, D; Heinemann, A; Zähler, S; Vogel, H; Höpker, W; Püschel, K; Kluge, S
There has been increasing use of invasive techniques, such as extracorporeal organ support, in intensive care units (ICU), and declining autopsy rates. Thus, new measures are needed to maintain high-quality standards. We investigated the potential of computed tomography (CT)-based virtual autopsy to substitute for medical autopsy in this setting. We investigated the potential of virtual autopsy by post-mortem CT to identify complications associated with medical devices in a prospective study of patients who had died in the ICU. Clinical records were reviewed to determine the number and types of medical devices used, and findings from medical and virtual autopsies, related and unrelated to the medical devices, were compared. Medical and virtual autopsies could be performed in 61 patients (Group M/V), and virtual autopsy only in 101 patients (Group V). In Group M/V, 41 device-related complications and 30 device malpositions were identified, but only with a low inter-method agreement. Major findings unrelated to a device were identified in about 25% of patients with a high level of agreement between methods. In Group V, 8 device complications and 36 device malpositions were identified. Device-related complications are frequent in ICU patients. Virtual and medical autopsies showed clear differences in the detection of complications and device malpositions. Both methods should supplement each other rather than one alone for quality control of medical devices in the ICU. Further studies should focus on the identification of special patient populations in which virtual autopsy might be of particular benefit. NCT01541982. Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
Full Text Available Objective. To explore the urinary biochemistry features of syndromes of traditional Chinese medicine (TCM such as syndrome of stagnation of liver Qi, spleen deficiency, liver Qi stagnation, and spleen deficiency (LSSDS in sub-optimal health status (SHS. Methods. 12 cases for each syndrome group in SHS were selected, 12 subjects were used as a normal control group, and 1H NMR detection was, respectively, carried out, and the data was corrected by the orthogonal signal correction (OSC and then adopted a partial least squares (PLS method for discriminate analysis. Results. The OSC-PLS (ctr analysis results of the nuclear overhauser enhancement spectroscopy (NOESY detection indicated that the syndromes in SHS could be differentiated, and there were significant differences in the levels of metabolites of the urine samples of the four groups; the biomarkers of LSSDS in SHS were found out. The contents of citric acid (2.54 and 2.66, trimethylamineoxide (3.26, and hippuric acid (3.98, 7.54, 7.58, 7.62, 7.66, 7.82, and 7.86 in the urine samples of LSSDS group were lower than that of the normal control group. Conclusion. There are differences in the 1H-NMR metabolic spectrum of the urine samples of the four groups, and the specific metabolic products of the LSSDS in SHS can be identified from metabonomics analysis.
Kawakami, Jun; Morales, Alvaro
We examined the serum levels of testosterone (T) (total and bioavailable) dehydroepiandrosterone (DHEA), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prostate-specific antigen (PSA) in men receiving treatment with luteinizing hormone releasing-hormone (LHRH) agonists for metastatic prostate cancer. In doing this, we want to determine the efficacy of these agents in lowering T levels and whether a possible relationship exists between PSA values, as a surrogate measure of tumour activity, and hormone levels. This was a single centre prospective study of patients on LHRH agonists. Of all the 100 eligible patients, 31 did not qualify (10 were receiving their first injection, 13 were on intermittent hormonal therapy, 7 refused to enter the trial and 1 patient's blood sample was lost). Therefore in total, 69 patients were included in the final analysis. Each patient had their blood sample drawn immediately before the administration of a LHRH agonist. The new proposed criteria of values are more commonly found in patients with suboptimal levels of testosterone receiving LHRH analogs, but the clinical importance of this finding has not been established. There is no significant difference with respect to hormonal levels reached among patients on a variety of LHRH agonists. Total testosterone determinations should be considered in patients on LHRH agonist therapy, particularly when the PSA values begin to rise since it may lead to further beneficial hormonal manipulation.
Azzarito, Tommaso; Venturi, Giulietta; Cesolini, Albino; Fais, Stefano
Tumor acidity is now considered an important determinant of drug-resistance and tumor progression, and anti-acidic approaches, such as Proton Pump inhibitors (PPIs), have demonstrated promising antitumor and chemo-sensitizing efficacy. The main purpose of the present study was to evaluate the possible PPI-induced sensitization of human melanoma cells to Paclitaxel (PTX). Our results show that PTX and the PPI Lansoprazole (LAN) combination was extremely efficient against metastatic melanoma cells, as compared to the single treatments, both in vitro and in vivo. We also showed that acidity plays an important role on the anti-tumor activity of these drugs, being detrimental for PTX activity, while crucial for the synergistic effect of PTX following pretreatment with LAN, due to its nature of pro-drug needing protonation for a full activation. We obtained straightforward results in a human melanoma xenograft model combining well tolerated LAN doses with suboptimal and poorly toxic doses of PTX. With this study we provide a clear evidence that the PPI LAN may be included in new combined therapy of human melanoma together with low doses of PTX. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Magalhães, Paula; White, K Geoffrey
We investigated suboptimal choice between different work requirements in pigeons (Columba livia), namely the sunk cost effect, an irrational tendency to persist with an initial investment, despite the availability of a better option. Pigeons chose between two keys, one with a fixed work requirement to food of 20 pecks (left key), and the other with a work requirement to food which varied across conditions (center key). On some trials within each session, such choices were preceded by an investment of 35 pecks on the center key, whereas on others they were not. On choice trials preceded by the investment, the pigeons tended to stay and complete the schedule associated with the center key, even when the number of pecks to obtain reward was greater than for the concurrently available left key. This result indicates that pigeons, like humans, commit the sunk cost effect. With higher work requirements, this preference was extended to trials where there was no initial investment, so an overall preference for the key associated with more work was evident, consistent with the work ethic effect. We conclude that a more general work ethic effect is amplified by the effect of the prior investment, that is, the sunk cost effect. Copyright © 2013 Elsevier B.V. All rights reserved.
Jin, Harry; Friedman, Mackey Reuel; Lim, Sin How; Guadamuz, Thomas E; Wei, Chongyi
Men who have sex with men and are sex workers (MSMSW) are disproportionately affected by the growing and emerging HIV epidemic. As sex work and same-sex behavior are heavily stigmatized and often illegal in most Asian countries, HIV research focusing on MSMSW has been limited. The goal of this analysis is to examine HIV testing practices and identify correlates of HIV testing among MSMSW in Asia. The Asia Internet MSM Sex Survey, an online cross-sectional survey of 10,861 men who have sex with men (MSM), was conducted in 2010. Data on sociodemographic characteristics, HIV testing behaviors, and sexual behaviors were collected. Five hundred and seventy-four HIV-negative/unknown respondents reported receiving payment for sex with men at least once in the past 6 months and were included in this analysis. Multivariable logistic regression was conducted to identify independent correlates of HIV testing in the past year. About half (48.6%) of the participants had been tested for HIV at least once within the past year, and 30.5% had never been tested. We also found that MSMSW participants who engaged in risky behaviors were less likely to be tested. While one might expect a high HIV testing rate among MSMSW due to the risks associated with engaging in sex work, we found that HIV testing uptake is suboptimal among MSMSW in Asia. These results suggest that targeted HIV prevention and testing promotion among MSMSW are needed.
Beals, Kim; Darnell, Matthew E; Lovalekar, Mita; Baker, Rachel A; Nagai, Takashi; San-Adams, Thida; Wirt, Michael D
The purpose of this study was to evaluate the nutrient intake of male and female Soldiers in the 101 st Airborne Division (Air Assault) compared to sports nutrition standards for athletes, and to identify suboptimal eating characteristics that may impair physical performance and jeopardize military readiness. Male and female Soldiers from the 101 st Airborne Division (Air Assault) completed a 24-hour dietary recall and nutrition history questionnaire before anthropometric and body composition measurements were taken. Compared to sports nutrition guidelines, Soldiers of the 101 st under consume carbohydrates (males: 3.9 ± 2.0 vs. 5.0 g/kg, p < 0.001; females: 4.0 ± 2.1 vs. 5.0 g/kg, p = 0.001), male Soldiers eat too much fat (32.4% of kcal vs. <30% of kcal, p = 0.000) and saturated fat (males: 10.5 ± 3.9% of kcal vs. 10.0% of kcal, p = 0.044), and both males and females follow a meal pattern that may not optimize energy availability throughout the day. Eating too much fat and under fueling carbohydrate may negatively impact the adaptations to physical training and compromise overall health. Although Soldiers continue to participate in arduous training programs, future research should be aimed at determining the energy and macronutrient needs to fuel and recover from specific types of military training. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.
Benzaquen, David; Delouya, Guila; Ménard, Cynthia; Barkati, Maroie; Taussky, Daniel
In prostate seed brachytherapy, a D 90 of prostate-specific antigen + 2). Univariate and multivariate analyses were performed, adjusting for known prognostic factors such as D 90 and prostate-specific antigen density (PSAD) of ≥0.15 ng/mL/cm 3 , to evaluate their ability to predict BF. Median followup for patients without BF was 72 months (interquartile range 56-96). BF-free recurrence rate at 5 years was 95% and at 8 years 88%. In univariate analysis, PSAD and cancer of the prostate risk assessment score were predictive of BF. On multivariate analysis, none of the factors remained significant. The best prognosis had patients with a low PSAD (<0.15 ng/mL/cm 3 ) and an optimal implant at 30 days after implantation (as defined by D 90 ≥ 130 Gy) compared to patients with both factors unfavorable (p = 0.006). A favorable PSAD was associate with a good prognosis, independently of the D 90 (<130 Gy vs. ≥130 Gy, p = 0.7). Patients with a PSAD of <0.15 ng/mL/cm 3 have little risk of BF, even in the case of a suboptimal implant. These results need to be validated in other patients' cohorts. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
Unar-Munguía, Mishel; Meza, Rafael; Colchero, M Arantxa; Torres-Mejía, Gabriela; de Cosío, Teresita Gonzalez
Exclusive breastfeeding and longer breastfeeding reduce women's breast cancer risk but Mexico has one of the lowest breastfeeding rates worldwide. We estimated the lifetime economic and disease burden of breast cancer in Mexico if 95% of parous women breastfeed each child exclusively for 6 months and continue breastfeeding for over a year. We used a static microsimulation model with a cost-of-illness approach to simulate a cohort of Mexican women. We estimated breast cancer incidence, premature mortality, disability-adjusted life years (DALYs), medical costs, and income losses due to breast cancer and extrapolated the results to 1.116 million Mexican women of age 15 in 2012. Costs were expressed in 2015 US dollars and discounted at a 3% annual rate. We estimated that 2,186 premature deaths (95% CI 2,123-2,248), 9,936 breast cancer cases (95% CI 9,651-10,220), 45,109 DALYs (95% CI 43,000-47,217), and $245 million USD (95% CI 234-256) in medical costs and income losses owing to breast cancer could be saved over a cohort's lifetime. Medical costs account for 80% of the economic burden; income losses and opportunity costs for caregivers account for 15 and 5%, respectively. In Mexico, the burden of breast cancer due to suboptimal breastfeeding in women is high in terms of morbidity, premature mortality, and the economic costs for the health sector and society.
Cogoni, Marco; Busonera, Giovanni; Anedda, Paolo; Zanetti, Gianluigi
We generalize previous studies on critical phenomena in communication networks [1,2] by adding computational capabilities to the nodes. In our model, a set of tasks with random origin, destination and computational structure is distributed on a computational network, modeled as a graph. By varying the temperature of a Metropolis Montecarlo, we explore the global latency for an optimal to suboptimal resource assignment at a given time instant. By computing the two-point correlation function for the local overload, we study the behavior of the correlation distance (both for links and nodes) while approaching the congested phase: a transition from peaked to spread g(r) is seen above a critical (Montecarlo) temperature Tc. The average latency trend of the system is predicted by averaging over several network traffic realizations while maintaining a spatially detailed information for each node: a sharp decrease of performance is found over Tc independently of the workload. The globally optimized computational resource allocation and network routing defines a baseline for a future comparison of the transition behavior with respect to existing routing strategies [3,4] for different network topologies.
Henjum, Sigrun; Lilleengen, Anne Marie; Aakre, Inger; Dudareva, Anna; Gjengedal, Elin Lovise Folven; Meltzer, Helle Margrete; Brantsæter, Anne Lise
Breastfed infants depend on sufficient maternal iodine intake for optimal growth and neurological development. Despite this, few studies have assessed iodine concentrations in human milk and there is currently no published data on iodine status among lactating women in Norway. The aim of this study was to assess iodine concentrations in breast milk (BMIC) in lactating women and estimate iodine intake. Five Mother and Child Health Centres in Oslo were randomly selected during 2016, and 175 lactating women between 2nd and 28th weeks postpartum participated. Each of the women provided four breastmilk samples which were pooled and analysed for iodine concentrations. Participants also provided information on iodine intake from food and supplements covering the last 24 h and the habitual iodine intake (food frequency questionnaire). The median (p25, p75 percentiles) BMIC was 68 (45, 98) µg/L and 76% had BMIC food (p25, p75) was 121 (82, 162) µg/day and the total intake (food and supplements) was 134 (95, 222) µg/day. The majority of lactating women had suboptimal BMIC and inadequate intake of iodine from food and supplements.
Krawczyk, Marian; Sawatzky, Richard
This study is part of an overarching research initiative on the development and integration of an electronic Quality of Life and Practice Support System (QPSS) that uses patient-reported outcome and experience measures in clinical practice. The current study focused on palliative nurse consultants trialing the QPSS with older hospitalized adults receiving acute care. The primary aim of the study was to better understand consultants' and patients' experiences and perspectives of use. The project involved two nurse specialists within a larger palliative outreach consult team (POCT) and consenting older adult patients (age 55+) in a large tertiary acute care hospital in western Canada. User-centered design of the QPSS was informed by three focus groups with the entire POCT team, and implementation was evaluated by direct observation as well as interviews with the POCT nurses and three patients. Thematic analysis of interviews and field notes was informed by theoretical perspectives from social sciences. Result Over 9 weeks, the POCT nurses used the QPSS at least once with 20 patients, for a total of 47 administrations. The nurses most often assisted patients in using the QPSS. Participants referenced three primary benefits of relational use: enhanced communication, strengthened therapeutic relations, and cocreation of new insights about quality of life and care experiences. The nurses also reported increased visibility of quality of life concerns and positive development as relational care providers. Significance of results Participants expressed that QPSS use positively influenced relations of care and enhanced practices consistent with person-centered care. Results also indicate that electronic assessment systems may, in some instances, function as actor-objects enabling new knowledge and relations of care rather than merely as a neutral technological platform. This is the first study to examine hospital palliative consult clinicians' use of a tablet-based system
Hartgerink, J M; Cramm, J M; Bakker, T J E M; van Eijsden, A M; Mackenbach, J P; Nieboer, A P
To identify predictors of relational coordination among professionals delivering care to older patients. Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. This study was performed in spring 2010 among team members delivering care to older hospitalized patients (192 respondents; 44% response rate) in one hospital. Relational coordination was measured by the Relational Coordination survey; team climate by the Team Climate Inventory and questions were asked about participation in multidisciplinary team meetings and disciplines represented in these meetings. To account for the hierarchical structure, a multilevel analysis was performed. Correlation analysis revealed a positive relationship among being female, being a nurse and relational coordination; medical specialists showed a negative relationship. The number of disciplines represented during multidisciplinary team meetings and team climate were positively related with relational coordination. The multilevel analysis showed a positive relationship between the number of disciplines represented during multidisciplinary team meetings and team climate with relational coordination. The enhancement of team climate and attendance of diverse professionals during multidisciplinary team meetings are expected to improve relational coordination. Furthermore, this study underscores the importance of enhancing relational coordination between medical specialists and other professionals. © 2013 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
McNamara, Patrick J; Shivananda, Sandesh P; Sahni, Mohit; Freeman, David; Taddio, Anna
Persistent pulmonary hypertension of the newborn is a common problem with significant morbidity and mortality. Inhaled nitric oxide is the standard care, but up to 40% of neonates are nonresponders. Milrinone is a phosphodiesterase III inhibitor which increases the bioavailability of cyclic adenosine monophosphate and has been shown to improve pulmonary hemodynamics in animal experimental models. The primary objective was to investigate the pharmacological profile of milrinone in persistent pulmonary hypertension of the newborn. Secondary objectives were to delineate short-term outcomes and safety profile. An open label study of milrinone in neonates with persistent pulmonary hypertension of the newborn was conducted. Patients received an intravenous loading dose of milrinone (50 μg/kg) over 60 mins followed by a maintenance infusion (0.33-0.99 μg/kg/min) for 24-72 hrs. Physiologic indices of cardiorespiratory stability and details of cointerventions were recorded. Serial blood milrinone levels were collected after the bolus, following initiation of the maintenance infusion to determine steady state levels, and following discontinuation of the drug to determine clearance. Echocardiography was performed before and after (1, 12 hrs) milrinone initiation. Milrinone. Eleven neonates with a diagnosis of persistent pulmonary hypertension of the newborn who met eligibility criteria were studied. The median (SD) gestational age and weight at birth were 39.2 ± 1.3 wks and 3481 ± 603 g. The mean (± sd) half-life, total body clearance, volume of distribution, and steady state concentration of milrinone were 4.1 ± 1.1 hrs, 0.11 ± 0.01 L/kg/hr, 0.56 ± 0.19 L/kg, and 290.9 ± 77.7 ng/mL. The initiation of milrinone led to an improvement in PaO2 (p = 0.002) and a sustained reduction in FIO2 (p milrinone treatment. The pharmacokinetics of milrinone in persistent pulmonary hypertension of the newborn is consistent with published data. The administration of intravenous
Abdulai, Issaka; Vaast, Philippe; Hoffmann, Munir P; Asare, Richard; Jassogne, Laurence; Van Asten, Piet; Rötter, Reimund P; Graefe, Sophie
Cocoa agroforestry is perceived as potential adaptation strategy to sub-optimal or adverse environmental conditions such as drought. We tested this strategy over wet, dry and extremely dry periods comparing cocoa in full sun with agroforestry systems: shaded by (i) a leguminous tree species, Albizia ferruginea and (ii) Antiaris toxicaria, the most common shade tree species in the region. We monitored micro-climate, sap flux density, throughfall, and soil water content from November 2014 to March 2016 at the forest-savannah transition zone of Ghana with climate and drought events during the study period serving as proxy for projected future climatic conditions in marginal cocoa cultivation areas of West Africa. Combined transpiration of cocoa and shade trees was significantly higher than cocoa in full sun during wet and dry periods. During wet period, transpiration rate of cocoa plants shaded by A. ferruginea was significantly lower than cocoa under A. toxicaria and full sun. During the extreme drought of 2015/16, all cocoa plants under A. ferruginea died. Cocoa plants under A. toxicaria suffered 77% mortality and massive stress with significantly reduced sap flux density of 115 g cm -2 day -1 , whereas cocoa in full sun maintained higher sap flux density of 170 g cm -2 day -1 . Moreover, cocoa sap flux recovery after the extreme drought was significantly higher in full sun (163 g cm -2 day -1 ) than under A. toxicaria (37 g cm -2 day -1 ). Soil water content in full sun was higher than in shaded systems suggesting that cocoa mortality in the shaded systems was linked to strong competition for soil water. The present results have major implications for cocoa cultivation under climate change. Promoting shade cocoa agroforestry as drought resilient system especially under climate change needs to be carefully reconsidered as shade tree species such as the recommended leguminous A. ferruginea constitute major risk to cocoa functioning under
Jensen, Jens Christian; Haahr, Jens Peder; Frost, Poul; Andersen, Johan Hviid
Musculoskeletal pain conditions remain a major cause of care-seeking in general practice. Not all patients with musculoskeletal pain (MP) seek care at their general practitioner (GP), but for those who do, the GP's knowledge of what work-related factors might have influenced the patient's decision to seek care could be important in order to give more well-founded advice to our patients. The objective of this study was to elucidate the effects of workloads on care-seeking for back pain or upper extremity pain during an eighteen-month follow-up period. This is a prospective study with a baseline questionnaire and eighteen-month follow-up. Among the registered patients of 8 GPs, we identified 8,517 persons between 17 and 65 years of age, who all received the questionnaire. A total of 5,068 (59.5 %) persons answered. During the eighteen months of follow-up, we used the International Classification for Primary Care (ICPC) to identify all care-seekers with either back pain or upper extremity pain. Of these, all currently employed persons were included in our analysis, in all 4,325 persons. For analysis, we used Cox proportional hazards regression analysis. Analyses were stratified by gender. High levels of heavy lifting, defined as the upper tertile on a categorical scale, were associated with care-seeking for back pain (HR 1.90 [95 % CI: 1.14-3.15]) and upper extremity pain (HR 2.09 [95 % CI: 1.30-3.38]) among males, but not in a statistically significant way among females. Repetitive work and psychosocial factors did not have any statistically significant impact on care-seeking for neither back pain nor upper extremity pain. Work-related factors such as heavy lifting do, to some extent, contribute to care-seeking with MP. We suggest that asking the patient about physical workloads should be routinely included in consultations dealing with MP.
Full Text Available Aims: The aim of the present study is to assess the level and areas of stress among care givers nursing their loved ones suffering from cancer. Setting and Design: An assessment of care givers′ stress providing care to cancer patients at Cipla Palliative Care Center was conducted. The study involves data collection using a questionnaire and subsequent analysis. Materials and Methods: A close-ended questionnaire that had seven sections on different aspects of caregivers′ stress was developed and administered to 137 participants and purpose of conducting the survey was explained to their understanding. Caregivers who were willing to participate were asked to read and/or explained the questions and requested to reply as per the scales given. Data was collected in the questionnaires and was quantitatively analyzed. Results: The study results showed that overall stress level among caregivers is 5.18 ± 0.26 (on a scale of 0-10; of the total, nearly 62% of caregivers were ready to ask for professional help from nurses, medical social workers and counselors to cope up with their stress. Conclusion: Stress among caregivers ultimately affects quality of care that is being provided to the patient. This is also because they are unprepared to provide care, have inadequate knowledge about care giving along with financial burden, physical and emotional stress. Thus interventions are needed to help caregivers to strengthen their confidence in giving care and come out with better quality of care.
Tseng, Phillip; Kaplan, Robert S; Richman, Barak D; Shah, Mahek A; Schulman, Kevin A
Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of
Lamont, Scott; Jeon, Yun-Hee; Chiarella, Mary
This integrative review aims to provide a synthesis of research findings of health-care professionals' knowledge, attitudes and behaviours relating to patient capacity to consent to or refuse treatment within the general hospital setting. Search strategies included relevant health databases, hand searching of key journals, 'snowballing' and expert recommendations. The review identified various knowledge gaps and attitudinal dispositions of health-care professionals, which influence their behaviours and decision-making in relation to capacity to consent processes. The findings suggest that there is tension between legal, ethical and professional standards relating to the assessment of capacity and consent within health care. Legislation and policy guidance concerning capacity assessment processes are lacking, and this may contribute to inconsistencies in practice.
Shepherd, Daniel; Csako, Rita; Landon, Jason; Goedeke, Sonja; Ty, Kelly
Parenting a child with autism spectrum disorder (ASD) can be stressful. Understanding parent's perceptions of their stress and their child's ASD-related symptoms is important for both the well-being of parent and child and for other reasons, such as intervention adherence and diagnostic accuracy. We report parent (N = 570) ratings of both their ASD Care-Related Stress scores and their child's symptoms in relation to the child's exposure to five mainstream ASD interventions. Differences across intervention history in the way parents perceive their child's symptoms and rate the stressfulness of performing ASD-related parenting duties were found.
Aydemir, Cumhur; Onay, Huseyin; Oguz, Serife Suna; Ozdemir, Taha Resid; Erdeve, Omer; Ozkinay, Ferda; Dilmen, Ugur
Preterm neonates are susceptible to infection due to a combination of sub-optimal immunity and increased exposure to invasive organisms. Invasive fungal infections are associated with significant morbidity and mortality among preterm infants cared for in the neonatal intensive care unit (NICU). Mannose-binding lectin (MBL) is a component of the innate immune system, which may be especially important in the neonatal setting. The objective of this study was to investigate the presence of any association between MBL gene polymorphism and nosocomial invasive fungal infection in preterm neonates. Codon 54 (B allele) polymorphism in exon 1 of the MBL gene was investigated in 31 patients diagnosed as nosocomial invasive fungal infection and 30 control preterm neonates. AB genotype was determined in 26% and 30% of patient and control groups, respectively, and the difference was not statistically significant. AA genotype was determined in 74% of the patient group and in 67% of the control group, and the difference was not statistically significant. B allele frequency was not different significantly in the patient group (13%) compared to the control group (18%). In our study, no relationship was found between MBL codon 54 gene polymorphism and the risk of nosocomial invasive fungal infection in preterm neonates in NICU.
Yeung, Simon S
This study aims to preliminary explore the work related and individual factors that contributed to the occurrence of low back pain (LBP) that affected work activities of Personal Care Workers (PCWs). A cross-sectional study was conducted to 36 PCWs in an old age home of Hong Kong. The study is divided into three parts: 1) a questionnaire to document the workload exposure factors and the musculoskeletal symptoms survey of the PCWs, 2) work posture evaluation; and 3) an evaluation of the physical fitness and lifting capacity of the PCWs. Univariate analyses were used to explore the risk factors associated with LBP that affected work activities. The results indicated that individual physical profile and lifting capacities did not contribute to occurrence of low back pain at work. For the work demand factors, the perceived physical demands in lifting and lowering heavy objects, awkward sustain neck and back postures, loading on the back, and perceived effort of cleaning task contributed to the occurrence of LBP. For the physical environment factors, thermal stress and improper ventilation were associated with the occurrence of LBP cases. For the individual factor, LBP cases were associated with workers' self perceived muscular effort, and perceived risk of mental illness in response to work requirements.
Vila-Rigat, Rosa; Panadès Valls, Rafael; Hernandez Huet, Enric; Sivecas Maristany, Joan; Blanché Prat, Xavier; Muñoz-Ortiz, Laura; Torán Monserrat, Pere; Rabell Santacana, Ventura
To determine the prevalence of occupational asthma (OA) and work-exacerbated asthma (WEA) among asthmatic patients diagnosed in Primary Health Care (PHC). To analyze the impact at PHC level caused by under-diagnosis and inappropriate referral of OA. A descriptive, cross-sectional multicenter study in patients aged between 16 and 64years diagnosed with asthma, according to their medical record; all were working or had worked, and were assigned to one of 16 PHC centers in a healthcare district. Based on the responses to the questionnaire completed at the study visit, which included a thorough review of the subject's entire working history, patients were classified into three categories by an expert in occupational asthma: OA, WEA or common asthma (CA). Three hundred and sixty-eight patients completed the questionnaire. The prevalence of OA was 18.2% (25% in men and 14.6% in women, P=.046), and 54 patients (14.7%) were classified as WEA. The proportion of patients with work-related asthma (WRA) was therefore 32.9%. Asthmatic patients with WRA took more sick leave than CA patients (P<.001). A high prevalence of WRA was found, mostly treated in PHC. Under-diagnosis of WRA is widespread in PHC. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.
van der Molen, Thys
In the Western world, chronic obstructive pulmonary disease (COPD) is predominantly caused by long-term smoking, which results in pulmonary inflammation that is often associated with systemic inflammation. A number of co-morbid conditions, such as cardiovascular disease, muscle wasting, type 2 diabetes and asthma, may coexist with COPD; these and other co-morbidities not directly related to COPD are major causes of excess morbidity and mortality. This review sets out to explore the most frequent co-morbidities in COPD and their implications for treatment. Review of the literature on co-morbidities of COPD. Co-morbidities are frequent, but often remain undiagnosed in the COPD patient. In order to provide the best possible care for people with COPD, the physician should be aware of all potential co-morbidities that may arise, and the critical role that effective management of these co-morbidities can play in improving patient outcomes. Increased awareness of the potential co-morbidities of COPD, although potentially adding to the general practitioner's work burden, may provide insights into this difficult disease state and possibly improve each individual's prospects for effective management.
Nguyen, J; Cascione, M; Noori, S
Point-of-care ultrasonography (POCUS) is becoming increasingly available for neonatologists and pediatric subspecialists (PSS); however, concerns over potential litigation from possible missed diagnoses or incorrect management have been documented. This study aims to define the extent and quality of lawsuits filed against neonatologists and PSS related to POCUS. We conducted a retrospective study of all United States reported state and federal cases in the Westlaw database from January 1990 through October 2015. Cases were reviewed and included if either a neonatologist or PSS were accused of misconduct or the interpretation or failure to perform an ultrasound/echocardiogram was discussed. Descriptive statistics were used to evaluate the data. Our search criteria returned 468 results; 2 cases were determined to be relevant to the study objective. The two cases alleged a failure to perform a diagnostic test and implicated POCUS as an option. There were no cases of neonatologists and PSS being sued for POCUS performance or interpretation. This study of a major legal database suggests that POCUS use and interpretation is not a significant cause of lawsuits against neonatologists and PSS.
Tawfik, D S; Sexton, J B; Kan, P; Sharek, P J; Nisbet, C C; Rigdon, J; Lee, H C; Profit, J
To examine burnout prevalence among California neonatal intensive care units (NICUs) and to test the relation between burnout and healthcare-associated infection (HAI) rates in very low birth weight (VLBW) neonates. Retrospective observational study of provider perceptions of burnout from 2073 nurse practitioners, physicians, registered nurses and respiratory therapists, using a validated four-item questionnaire based on the Maslach Burnout Inventory. The relation between burnout and HAI rates among VLBW (<1500 g) neonates from each NICU was evaluated using multi-level logistic regression analysis with patient-level factors as fixed effects. We found variable prevalence of burnout across the NICUs surveyed (mean 25.2±10.1%). Healthcare-associated infection rates were 8.3±5.1% during the study period. Highest burnout prevalence was found among nurses, nurse practitioners and respiratory therapists (non-physicians, 28±11% vs 17±19% physicians), day shift workers (30±3% vs 25±4% night shift) and workers with 5 or more years of service (29±2% vs 16±6% in fewer than 3 years group). Overall burnout rates showed no correlation with risk-adjusted rates of HAIs (r=-0.133). Item-level analysis showed positive association between HAIs and perceptions of working too hard (odds ratio 1.15, 95% confidence interval 1.04-1.28). Sensitivity analysis of high-volume NICUs suggested a moderate correlation between burnout prevalence and HAIs (r=0.34). Burnout is most prevalent among non-physicians, daytime workers and experienced workers. Perceptions of working too hard associate with increased HAIs in this cohort of VLBW infants, but overall burnout prevalence is not predictive.
Full Text Available Abstract Background to investigate whether a structured physical exercise programme (PEP improves the recovery of general health in patients suffering from Stress-related Mental Disorder (SMD. Method Study design: randomised open trial in general practice. Patients from two regions in the Netherlands were included between September 2003 and December 2005, and followed up for 12 weeks. Intervention: the patients were referred to a physical therapist for instruction in and monitoring of physical exercise of an intermediate intensity. Following the Dutch Guidelines for Healthy Physical Exercise, the patients were instructed to exercise at least five times a week, for at least 30 minutes per day. Control group: usual care from the GP Outcome Primary: improvement of general health after 6 weeks according to the 'general health' dimension of the Short-Form 36. Secondary: total days off work, percentage that resumed work after 6 and 12 weeks, change in distress score and change in remaining SF36 dimensions after 6 and 12 weeks. Results out of 102 randomised patients (mean age 43, 60 (59% female, 70 (68% completed the trial, of whom 31 were in the intervention group. After 6 weeks, the mean (SD general health score was 54.6 (22.1 for the intervention group and 57.5 (19.2 for the controls. The corresponding effect size (Cohen's d with 95% confidence interval from analysis of covariance was -0.06 (-0.41, 0.30 indicating no effect on general health. No significant effects of the intervention were detected for any secondary outcome parameter either. Conclusion Notwithstanding the relatively high drop-out rate, our results suggest that referral to a physical therapist for structured physical exercise is not likely to be very effective in improving recovery from SMD. Trial registry Current Controlled Trials ISRCTN15609105
Abreu, Tatiana Fernandes Kerches de; Amendola, Fernanda; Trovo, Monica Martins
This article aims to identify the relational technologies used by Family Health Strategy nurses in their daily work when treating patients. Descriptive and cross-sectional study with qualitative approach; conducted between May and July 2015, in three Basic Health Units of the Southern Region of the Municipality of São Paulo, with 19 nurses of the Family Health Strategy. Data were collected through a semi-structured interview, and the speeches were fully transcribed and analyzed according to the technique of content analysis. From the speeches of the participants, three categories emerged, showing the unawareness of the concept, but the valorization of its use; which are the relational technologies used by the participating nurses (communication, listening, empathy and welcoming reception), as well as the report of barriers to the use of relational technologies. Although the nurses value the use of relational technologies, the participants denoted unawareness of the nomenclature and its associated concepts, suggesting superficiality in the understanding and use of these instruments in the context of care in the Family Health Strategy. Identificar as tecnologias relacionais utilizadas por enfermeiros de Estratégia Saúde da Família em seu cotidiano de trabalho no atendimento aos usuários. Estudo descritivo, transversal, com abordagem qualitativa; desenvolvido entre maio e julho de 2015, em três Unidades Básicas de Saúde da Região Sul do Município de São Paulo, com 19 enfermeiros da Estratégia Saúde da Família. Os dados foram coletados por meio de entrevista semiestruturada, e os discursos foram transcritos na íntegra, analisados segundo a técnica de análise de conteúdo. Das falas dos participantes, surgiram três categorias, que evidenciam o desconhecimento do conceito, mas valorização do uso; quais são as tecnologias relacionais utilizadas pelos enfermeiros participantes (comunicação, escuta, empatia e acolhimento), além do relato de barreiras
Assefa, Enyew; Tadesse, Mekonnen
The major causes for poor health in developing countries are inadequate access and under-use of modern health care services. The objective of this study was to identify and examine factors related to the use of antenatal care services using the 2011 Ethiopia Demographic and Health Survey data. The number of antenatal care visits during the last pregnancy by mothers aged 15 to 49 years (n = 7,737) was analyzed. More than 55% of the mothers did not use antenatal care (ANC) services, while more than 22% of the women used antenatal care services less than four times. More than half of the women (52%) who had access to health services had at least four antenatal care visits. The zero-inflated negative binomial model was found to be more appropriate for analyzing the data. Place of residence, age of mothers, woman's educational level, employment status, mass media exposure, religion, and access to health services were significantly associated with the use of antenatal care services. Accordingly, there should be progress toward a health-education program that enables more women to utilize ANC services, with the program targeting women in rural areas, uneducated women, and mothers with higher birth orders through appropriate media.
Cláudio Penido Campos Júnior
Full Text Available Despite improvements in care and rehabilitation of burned patients, infections still remain the main complication and death cause. Catheter-related infections are among the four most common infections and are associated with skin damage and insertion site colonization. There are few studies evaluating this kind of infection worldwide in this special group of patients. Padre Albino Hospital Burn Care Unit (PAHBCU is the only reference center in the Northwestern São Paulo for treatment of burned patients. This paper presents the results of a retrospective study aiming at describing the epidemiological and clinical features of catheter-related infections at PAHBCU.
Wodskou, Pernille Maria; Høst, Dorte; Godtfredsen, Nina
after implementation of a COPD disease management programme. METHODS: Seven focus groups and five individual interviews were held with 34 patients with severe or very severe COPD and two focus groups were held with eight of their relatives. Data were analysed using inductive content analysis. RESULTS...... with integrated care among COPD patients. A future effort in this field should be informed by detailed knowledge of the extent and relative importance of the identified problems. It should also be designed to address variable levels of severity of COPD and relevant comorbidities and to deliver care in ways...
Winkelman, Tyler N. A.; Heisler, Michele; Dalton, Vanessa K.
Our objective was to measure obstetric outcomes and delivery-related health care utilization and costs among pregnant women with multiple chronic conditions. We used 2013–2014 data from the National Inpatient Sample to measure obstetric outcomes and delivery-related health care utilization and costs among women with no chronic conditions, 1 chronic condition, and multiple chronic conditions. Women with multiple chronic conditions were at significantly higher risk than women with 1 chronic condition or no chronic conditions across all outcomes measured. High-value strategies are needed to improve birth outcomes among vulnerable mothers and their infants. PMID:29420168
Shanley, Leticia; Mittal, Vineeta; Flores, Glenn
The goal of this study was to identify the proportion of dehydration-related ambulatory care-sensitive condition hospitalizations, the reasons why these hospitalizations were preventable, and factors associated with preventability. A cross-sectional survey of primary care providers (PCPs), inpatient attending physicians, and parents was conducted in a consecutive series of children with ambulatory care-sensitive conditions admitted to an urban hospital over 14 months. Eighty-five children were diagnosed with dehydration. Their mean age was 1.6 years; most had public (74%) or no (17%) insurance, and were nonwhite (91%). The proportion of hospitalizations assessed as preventable varied from 12% for agreement among all 3 sources to 45% for any source. Parents identified inadequate prevention (50%), poor self-education (34%), and poor quality of care (38%) as key factors. PCPs identified parents providing insufficient home rehydration (33%), not visiting the clinic (25%), and not calling earlier (16%) as reasons. Inpatient attending physicians cited home rehydration (40%), delays in seeking care (40%), and lacking a PCP (20%) as contributors. Physicians (PCPs and inpatient attending physicians) were more likely than parents to describe the admission as inappropriate (75% vs 67% vs 0%; P dehydration-related hospitalizations may be preventable. Inadequate parental education by physicians, insufficient home rehydration, deferring clinic visits, insurance and cost barriers, inappropriate admissions, poor quality of care, and parental dissatisfaction with PCPs are the reasons that these hospitalizations might have been prevented.
Davtyan, Mariam; Olshansky, Ellen F; Brown, Brandon; Lakon, Cynthia
Despite progress made in the treatment and care of people living with HIV (PLWH), HIV-related stigma has remained persistent. Health care settings and workers have been identified as important sources of stigma. Studies have addressed the construct of stigma in U.S. health care settings, but mainly from the perspectives of PLWH. We used Grounded Theory to understand how health care workers conceptualized HIV-related stigma and to develop a model to project a purposive view of stigma in health care settings. Our model indicates that stigma may be rooted in historically derogatory representations of HIV and intensified by power inequalities. Stigma may be triggered by fear, inadequate clinical education and training, unintentional behaviors, and limited contact with PLWH. Study participants perceived stigma as injurious to patient and provider health outcomes. Additional research on provider perceptions of stigma and programs that encourage empowerment, communication, and training may be necessary for stigma reduction. Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Frick, Melissa A; Vachani, Carolyn C; Bach, Christina; Hampshire, Margaret K; Arnold-Korzeniowski, Karen; Metz, James M; Hill-Kayser, Christine E
The survivorship needs of patients living with chronic cancer (CC) and their use of survivorship care plans (SCPs) have been overlooked and underappreciated. A convenience sample of 39,088 SCPs completed for cancer survivors with an Internet-based SCP tool was examined; it included 5847 CC survivors (15%; CC was defined as chronic leukemia and/or recurrent/metastatic cancer of another nature). Patient-reported treatment effects and follow-up care patterns were compared between CC survivors and survivors treated with curative intent (CI). Responses from a follow-up survey regarding SCP satisfaction and use were reviewed. CC survivors had greater odds of experiencing multiple treatment-related effects than survivors treated with CI; these effects included fatigue, cognitive changes, dyspnea, peripheral neuropathy, lymphedema, and erectile dysfunction. Nearly half of CC survivors were managed by an oncologist alone, and they were less likely than CI patients to be comanaged by a primary care provider and an oncologist. Fewer SCPs were generated by health care providers (HCPs) for CC survivors versus CI survivors. A smaller proportion of CC users versus CI users rated their experience and satisfaction with the SCP tool as very good or excellent, and CC users were less likely to share the HCP summary with their health care team. A substantial number of CC survivors, often considered incurable but treatable, seek survivorship support. Tools to facilitate participation, communication, and coordination of care are valuable for these patients, and future iterations of SCPs should be designed to address the particular circumstances of living with CC. Cancer 2017;123:4268-4276. © 2017 American Cancer Society. © 2017 American Cancer Society.
Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Bosch, W.J.H.M. van den
Background: The concept of ‘continuity of care’ has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. Objective: In order to clarify the confusion of
Full Text Available Resources are one of the essential indicators for the functioning of the health care system. Better health care provision is an essential prerequisite for the export of services. Traditionally a competitive health care system is linked to a number of factors (price, quality, reliability, products and services largely determined by the new technologies, innovations and implementation the new methods. The authors of this article analyzed and collected data from the European Commission Eurostat and OECD data. Current situation in health care in Latvia is characterized by populations’ restricted access to health care services, high out-of-pocket payments and poor health outcomes of the population. More than 10% of Latvian population can’t afford medical care. The ratio of public funding for healthcare in Latvia is among the lowest in EU countries. Latvia spends 5.3% (USD PPP 1217 of GDP on health, lower than the OCED country average of 8.9% (USD PPP 3453. Latvia is facing a dramatic gap between the availability of hospital beds and long term care beds and the lowest prevalence of general medical prac