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PubMed2003

Patterns of use and harms associated with non-medical ketamine use.

AIM: To (1) identify current patterns of non-medical ketamine use; and (2) identify potential harms associated with non-medical ketamine use. DESIGN: Cross sectional survey of lifetime ketamine users. SETTING: Semi-structured interviews took place in public and private settings in Sydney Australia. PARTICIPANTS: One Hundred ketamine users. MEASUREMENTS: Self-reported experiences with and attitudes towards ketamine use. FINDINGS: Ketamine appeared to be added to an already extensive drug use repertoire of a well-educated and informed sample. Many users reported regularly experiencing effects such as an inability to speak, blurred vision, lack of co-ordination and increased body temperature, which resulted in some either reducing their dose or stopping use. CONCLUSIONS: Many users had experienced significant negative effects, such that some had either reduced their dose or stopped use altogether and expressed concerns over some others. This study reinforces the need to develop harm minimisation campaigns that match the experiences and attitudes of their target group through careful needs assessment and appropriate evaluation.

Adult↗
PubMed2001

Five-year compliance with hormone replacement therapy in postmenopausal Chinese women in Hong Kong.

OBJECTIVES: To assess 5-year compliance with hormone replacement therapy (HRT) in Hong Kong Chinese women and the reasons for long-term compliance or non-compliance. METHODS: A telephone survey using a standardized questionnaire was conducted in 187 postmenopausal women who had commenced HRT in a referral-only specialist clinic of a university teaching hospital 5 years previously. Over this 5-year period, the cohort had been referred out to primary care doctors once they had become stabilized on treatment. RESULTS: The 5-year compliance rate was 71.1%. The overall compliance rates were nearly the same from 2 and 5 years. 'Doctors' advice' was the most important reason for maintenance of long-term compliance, accounting for 88.0% of all compliant cases. The most frequent reason for non-compliance was that of the experience of side effects. Other important reasons were fear of cancer, fear of other side effects, and discouragement from other doctors. Overall, 16.0% of women expressed concern regarding potential side effects or risk of breast cancer. Younger age at menopause and at time of initial consultation, shorter duration of menopause at presentation and previous history of hysterectomy were associated with a higher degree of compliance at 5 years. Presence or absence of menopausal symptoms, on the other hand, was not a significant factor. CONCLUSIONS: The 5-year compliance rate in this cohort of Hong Kong Chinese women was comparable to that reported from predominantly Caucasian populations. The physicians' role in encouraging postmenopausal women to achieve long-term HRT compliance was observed.

Adult↗
PubMed2001

Impact of risk information in a patient education leaflet.

Informed consent requires the communication of information about possible adverse effects of treatment. Health professionals have expressed concern that increased provision of risk information may make patients unduly anxious and change their decisions about treatment. This study compared two patient leaflets about laparoscopy, one containing detailed information about potential side effects. Forty one consenting participants attending an outpatient gynaecology clinic and scheduled for an elective laparoscopic procedure were studied. They were randomly assigned to receive one of two leaflets after their consultation. Knowledge about laparoscopy, satisfaction with information provided, and anxiety were tested 2 days later, between the original consultation and their operation. Results showed that the leaflet containing detailed risk information was associated with greater knowledge about laparoscopy, higher satisfaction with information provision and no increase in anxiety. Provision of detailed information about possible adverse consequences of treatment can improve patients' understanding and satisfaction without inducing increased anxiety.

Adult↗
PubMed2003

Increasing patient participation in reproductive health consultations: an evaluation of "Smart Patient" coaching in Indonesia.

Paternalistic models of health care, social distance between patients and providers, and cultural norms discourage patients from playing an active role in health consultations. This study tested whether individual coaching can give family planning patients the confidence and communication skills to talk more openly and more vigorously with providers. Educators met with 384 Indonesian women in clinic waiting rooms and coached them on asking questions, expressing concerns, and seeking clarification. An analysis of audiotaped consultations found that patients who received coaching articulated significantly more questions and concerns than others. Coaching narrowed differentials in active communication by patient type, age, and assertiveness, but it widened differentials by patient education and socioeconomic class. The discontinuation rate at 8 months was lower in the intervention than the control condition, but the difference was only marginally significant.

Adolescent↗
PubMed2003

Shortage of influenza vaccine in 2000-2001: did it change patient beliefs?

OBJECTIVE: To determine which patient beliefs associated with influenza vaccination changed during a vaccine shortage year (2000-2001) from a nonshortage year (1999-2000). METHODS: Elderly patients (n=319), who had been previously interviewed about the 1999-2000 influenza season, were interviewed regarding the 2000-2001 season. Participants were from inner-city and suburban medical practices receiving influenza vaccine supply on time or late in the season. RESULTS: Although vaccination rates did not diminish due to the influenza vaccine shortage (73% in 1999-2000 vs 74% in 2000-2001), some patient attitudes changed. More respondents expressed concerns about the influenza vaccine (3% in 1999-2000 vs 12% in 2000-2001, p<0.0001), and fewer responded that friends thought that they should get the vaccine (75% 1999-2000 vs 66% 2000-2001, p=0.005); that if one person in the household "got the flu" others would also (71% 1999-2000 vs 67% 2000-2001, p<0.0001), and that "a person who does not get the flu shot will get influenza" (36% 1999-2000 vs 30% 2000-2001, p=0.02). CONCLUSIONS: The influenza vaccine shortage resulted in a small increase in concerns about influenza vaccine, even in a population with good access to vaccine and high vaccination rates. Vaccine availability updates should include reassurances of vaccine safety and efficacy.

Aged↗
PubMed2000

Being a case manager for persons with borderline personality disorder: perspectives of community mental health center clinicians.

The scope of case management has expanded to include persons with chronic, nonpsychotic disorders, in particular, persons diagnosed with borderline personality disorder. Despite more widespread use, literature about case management for persons with this disorder is limited. To address this gap in knowledge, a study of the day-to-day experiences of case managers who care for persons with borderline personality disorder was conducted. Seventeen community mental health center case managers gave their informed consent to participate in individual, in-depth interviews. The interviews were analyzed using an interpretive phenomenological research approach. The analysis showed a pattern of monitoring self-involvement. The case managers monitored themselves in terms of expressing concern and setting boundaries. These shared practices highlight a central and unique component of being a case manager for persons with borderline personality disorder, that is, the case manager's focus of attention is on self. By focusing on the self, case managers seek to retain control of the nature of the relationship. The author asserts that the matter to be resolved is not to determine whether retaining or relinquishing control is better, but rather, how best to help practitioners maintain a helpful relationship over time with persons who have borderline personality disorder. In an effort to accomplish this goal, questions about current helping practices and suggestions for working collaboratively with persons who have this diagnosis are provided.

Attitude of Health Personnel↗
PubMed1999

The experience of relapse to unsafe sexual behavior among HIV-positive, heterosexual, minority men.

The purpose of this qualitative study was to examine the phenomenon of relapse to unsafe sexual behavior in human immunodeficiency virus (HIV)-positive, heterosexual, minority men. In-depth interviews were conducted by using a purposive sample of 18 HIV-positive, heterosexual, minority men who were recruited from an outpatient acquired immunodeficiency syndrome (AIDS) clinic in upstate New York and a community-based HIV/AIDS service organization in New York City. All participants expressed concern about the seriousness and health threat of unsafe sexual behaviors. The perceived benefits and barriers to unsafe sexual practices were identified. Content analysis revealed the following themes related to relapse to unsafe sexual behavior: drug and alcohol use, state of mind, "looking good" and "helping" fallacies, male-female relationship issues, influence of friends, weighing the risks, sexual preparation, uncontrollable sexual urges, and the symbolic meaning of condoms. Clinical implications related to health assessment, interventions, and health education and prevention programs for HIV-positive heterosexual, minority men and their sexual partners are presented.

Adult↗
PubMed1997

[Ethical decisions making in neonatal intensive care. Survey among nursing staff in 2 French centers].

A European Concerted Action, Euronic, has been set up to study the attitudes and self-reported practices of the staff working in neonatal intensive care units about parent's information and ethical decisionmaking. This paper presents the results of a preliminary qualitative survey conducted in two French units and including 23 physicians and nurses. The answers indicate that withdrawal of treatments are part of their practices. Parents are never directly involved in the decision-making process. The decision to withdraw life sustaining treatments generate psychological distress among the caregivers. Nurses consider that they are more emotionally involved with the baby and the parents. They express concerns about painful treatments and life-prolonging therapies. Most respondents believe that an ethical committee would be of little help in the decision-making process and that the actual legislation should not be modified as it gives obligation for more in-depth consideration of each case.

Decision Making↗
PubMed2001

From competition to community: participatory learning and action among young, debt-bonded Vietnamese sex workers in Cambodia.

Community mobilisation strategies for HIV/AIDS prevention based on recognition of social vulnerability and concepts of empowerment have emerged at the forefront of international efforts to reduce the AIDS pandemic, increasingly replacing a focus on individual risk. This paper describes the start-up phase of a participatory learning and action project to create a sense of community identity as a first step towards collective action among some 300 young, debt-bonded, brothel-based migrant sex workers from Vietnam in Phnom Penh, Cambodia. The factors that make sex workers vulnerable to HIV also pose considerable barriers to mobilising them, due to competing interests between and among brothel owners and sex workers. Discussion and visual tools--e.g. a spider diagram of causes of unsafe sex and how to overcome these--are being used in group work to analyse concerns expressed by sex workers, along with survey questionnaires and in-depth interviews. In the second phase the project will address sensitive topics such as violence and unsafe sex in more depth, in hopes of protecting the emerging solidarity among sex workers and shifting the balance towards greater co-operation.

Adult↗
PubMed2001

The AMA Residency Training in Adolescent Preventive Services Project: report of the working group. The American Medical Association.

PURPOSE: To improve resident education in provision of adolescent preventive health care. The American Medical Association (AMA) Residency Training in Adolescent Preventive Services Project Working Group convened to identify specific goals and objectives (G&Os) for pediatric and family medicine resident education in adolescent clinical preventive services and recommend strategies to achieve these G&Os. METHODS: Iterative review process involving members of the working group, nine experienced teaching faculty and 16 resident physicians from family medicine and pediatric training programs, and an advisory board. RESULTS: We achieved consensus on appropriate G&Os for pediatric and family medicine residency education in adolescent clinical preventive services. Faculty and residents expressed concerns about achieving G&Os because of challenges to implementing effective training and evaluation strategies. Suggestions for achieving G&Os included development of an adolescent clinical preventive services curriculum and evaluation program that could be adapted for use in a variety of training program structures. Faculty and residents anticipated the success of a training curriculum would be influenced by: (a) availability of adequate numbers of skilled teaching faculty; (b) availability of time and support for faculty development and teaching efforts; and (c) exposure of residents to adequate numbers of adolescent patients in settings where there are clear expectations for delivery of comprehensive preventive services. CONCLUSIONS: The AMA Residency Training in Adolescent Preventive Services Project Working Group presents G&Os for organizing training experiences in adolescent clinical preventive services in family medicine and pediatric residency training programs and recommends strategies to achieve these G&Os.

Adolescent↗
PubMed2000

Utilization of electronic communication (E-mail) with patients at university and college health centers.

PURPOSE: To examine the utilization and potential uses and problems of electronic communication with patients. METHODS: University and college health centers were surveyed about the type of utilization and policies of electronic communication with patients. The survey group consisted of 99 health centers predominantly serving students representing small-, medium-, and large-sized public and private colleges and universities. Eighty-nine health centers completed the survey. RESULTS: Of the responding health centers, 63.6% use some form of electronic communication with patients. Twenty-seven percent of the health centers give out some form of medical advice via E-mail or the Internet; 14.7% give out some laboratory results via E-mail; 3.4% make appointments via E-mail; and 63.6% give out administrative advice by E-mail. While there was consistent concern expressed about confidentiality and security, only five health centers had a policy about electronic communication. Uses were most common in nonclinical areas but did include health education, Web sites, medical advice, laboratory results, appointment-making or confirmation, and contacting hard-to-reach patients including those studying abroad. CONCLUSIONS: While electronic communication with patients was common, provision of direct medical advice was less common. Issues receiving little attention include determining the types of electronic communication that is acceptable to staff and students, determining the level of security of their current information system, educating staff about confidentiality and security issues, and establishing a comprehensive policy regarding electronic communication with patients.

Adolescent↗
PubMedDate not supplied

Satisfaction with home healthcare services for clients with HIV: preliminary findings.

The Visiting Nurse Service of New York and Empire Blue Cross and Blue Shield implemented in 1990 the "At Home Options Program" (AHOP), an enhanced package of home care and other noninpatient services for HIV-positive clients. AHOP aims to reduce total treatment costs and hospital days. Clients (N = 52) completed mailed satisfaction surveys. Overall, clients were very satisfied with AHOP services. Clients expressed concerns, however, about the uneven quality of substitute paraprofessionals, and said they needed easier access to a knowledgeable healthcare professional. Operational concerns included inadequate information dissemination and administrative oversights. Findings will inform subsequent program activities.

Adult↗
PubMed2001

The impact of staffing and the organization of work on patient outcomes and health care workers in health care organizations.

BACKGROUND: Numerous reports in the popular press express concern about the restructuring or lowering of staffing levels in health care organizations and the impact on the quality of patient care. Overtime and other extended shifts also represent work stresses for health care workers. This article reviews the research literature on the relationships among staffing, organization of work, and patient outcomes, and it discusses research findings on the relationship between staffing and the health of health care workers. RESEARCH ON STAFFING, ORGANIZATION, AND PATIENT OUTCOMES/STAFF WELL-BEING: Safe staffing level requirements have been identified for nursing homes, but only in extremely limited cases for hospitals, home care, or other health settings. There is little information about the impact of staffing levels and the organization of work on health personnel or on patient outcomes. There is almost no information about staffing and patient outcomes in home health and ambulatory care. Much of the research on staffing and quality has been discipline specific; future research should reflect the interdisciplinary nature of health care delivery rather than the impact of a particular occupation. RESEARCH USE: Research is conducted to increase the scientific base per se and to inform decision making. Who should decide staffing levels and the organization of work? Professionals, employers/owners, the government, and consumers all have significant interest in staffing levels and the organization of care. Improving health care quality requires research about the critical staffing and organization of work variables. This requires obtaining appropriate data, conducting the research, and widely disseminating the findings.

Decision Making, Organizational↗
PubMed1995

Current status of residency programs: survey of program directors.

RATIONALE AND OBJECTIVES: This survey was compiled to provide current data on the structure and content of radiology residency programs and the role of the residency program director. METHODS: A survey, created in electronic form and on paper, was distributed to all United States academic, private, and military radiology residency program directors. RESULTS: Of the 202 survey forms distributed, 168 (83%) were completed and returned. Eighty percent of respondents support national curriculum guidelines, but most do not favor national curriculum requirements. About half (53%) of programs spend 6 months in "view box" nuclear medicine; others provide some experience by lectures and on-call time. Most programs (60%) relieve residents of some call during the senior year. Some programs (28%) allow seniors time away from clinical duties to study for the oral board exam, and 17% permit time away to study for the written boards. Seventy-eight percent of programs have had a "problem resident," and 47% have asked a resident to leave the program. Directors' most frequently expressed concern was threat of diminished residency numbers due to decreased funding.

Attitude of Health Personnel↗
PubMed1999

Effect of Health Care Financing Administration regulation on radiology fellowship training.

RATIONALE AND OBJECTIVES: The purpose of this study was to assess the effect of Health Care Financing Administration (HCFA) regulations on radiology fellowship training. MATERIALS AND METHODS: Surveys were sent to 157 fellowship program directors in body imaging and vascular/ interventional radiology. Questions addressed program accreditation status, faculty supervision of fellows, and any change in faculty supervision of fellows in response to HCFA's revised plan for Medicare Part B reimbursement. RESULTS: Eighty of 157 (51%) surveys were returned. Thirty (37%) respondents indicated supervision of fellows had changed after institution of the new HCFA rules in July 1996. Vascular/interventional program directors (n = 25, 49%) were more likely to have changed their practice than body imaging program directors (n = 5, 17%). Nearly all respondents (29 of 30, 97%) indicating a change stated supervision had increased. Twenty-seven (33%) respondents also indicated faculty supervision was beyond that necessary for patient care and house staff education; most of these respondents (21 of 27, 78%) stated the new HCFA regulations were responsible. Many program directors also expressed concern the HCFA regulations might prevent fellows from obtaining sufficient experience to effectively learn independent clinical decision-making. CONCLUSION: HCFA regulations intended to address attending physician billing practices at teaching institutions may have had the unintended effect of substantively altering the training of radiology fellows.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Elder abuse and neglect.

Home care providers have a professional and legal obligation to help prevent their elderly patients from being abused and neglected by family members and other home care providers. The elderly are often in a vulnerable situation because they depend on family members or others to help with personal care, housekeeping chores, and money management. A recent article in a major newspaper illustrates the problem. It reported that Mr. X, who was 84 years old, had been without food or water while he lay curled in the trunk of his car for 2 days before he was found by the police. When found, he reported that he saw daylight only when his housekeeper lifted the car trunk lid to ask him if her forgery of his check looked authentic. After he was rescued, he acknowledged that he was confused about why his housekeeper, who had befriended him, had turned on him. He expressed concern for her and hoped she would get a break in her sentencing. "She didn't kill me," he said. This situation is not that unusual. Elder abuse and neglect is a major public health problem in the United States, with most cases hidden from public scrutiny. The National center on Elder Abuse reports that cases of domestic abuse against the elderly increased from 117,000 in 1986 to 241,000 in 1994, and that represented only a fraction of older Americans who were abused and neglected in their homes. The Center estimates that 818,000 elderly Americans were victims of various types of domestic abuse in 1994. They believe the rise in reported cases illustrates a growing pattern of violence and neglect among the nation's expanding elderly population.

Aged↗
PubMed1998

Talk about cancer: environment and health in Oceanpoint.

Based on an ethnographic study, this paper explores one Australian community's 'popular epidemiology' of the role of the environment on health. Residents express concern about cancer risks due to contamination from a land-fill dump site and from radioactivity from previous mining activities. These concerns carry a range of meanings, not only regarding the threats to the physical place of Oceanpoint, but the social space the community occupies and the values they espouse. The perceptions of health risks in this location involve a contest over the cultural politics of place, the political economy of development and the sense of a former authentic 'community' that is being lost and disempowered from controlling its future.

Australia↗
PubMed2000

Situating vision in the world.

Recently, there has been a great deal of interest in what has been called 'situated cognition', which has included claims that certain forms of representation are inadequate for modeling active organisms or agents such as humans and robots. In this article, I suggest that a weakness in classical theories of visual representation is the way in which representations connect with the real world, which may account for many of the concerns expressed by the situated cognition community. Specifically, I claim that what current theories lack is any provision for a certain form of direct, preconceptual connection between objects in the visual world (visual objects or proto-objects) and their representations in the visual system. This type of connection is akin to what philosophers and semanticists have referred to as an 'indexical' or 'demonstrative' reference and what some cognitive scientists have referred to as 'deictic pointers'. I explain why such a mechanism is needed and suggest that many workers have, in fact, been studying precisely this under the term 'visual index'. The visual index hypothesis is illustrated with the results of some relevant experiments, including multiple object tracking, visual routines and subset-selected visual searches. Indexing theory provides a synthesis that has profound implications for explaining a wide range of psychophysical findings, certain results in infant cognitive development and also some ancient problems in the philosophy of mind.

Journal Article↗