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PubMed1999

A descriptive study of the extent to which self-perceived needs of parents are met in paediatric units in Iceland.

The purpose of this study was to identify the extent to which parents of 2-12-year-old hospitalized children perceive their needs to be met in paediatric units, what variables influence parents' perception, and whether parents need help from the hospital to meet their needs. Parents perceived that most of their needs were met fully or to some extent. The need to be able to stay with the child 24 h a day was perceived as fully met by all parents. Needs perceived as important but poorly met were as follows: written information about the child's health status, information about financial assistance and follow-up after discharge. Independent variables identified as being related to the extent to which individual needs were met were as follows: parents' age (p < or = 0.05), distance between home and hospital (p < or = 0.05), parents' education (p < or = 0.05), length of hospital stay (p < or = 0.01) and severity of child's illness (p < or = 0.01). Most parents perceived that they needed help from the hospital to meet their needs. These findings call for identification of effective interventions to meet parents' needs.

Adult↗
PubMed2002

Objective and subjective need for orthodontic treatment in Stockholm County.

The objective and subjective need for orthodontic treatment according to a modified version of the treatment priority index of the Swedish National Board of Health and Welfare (index scores 0 to 4), was studied in 1281 children and teenagers, aged between 8 and 16 years and living in the Stockholm area. Furthermore, differences between different parts of the Stockholm County with respect to need for orthodontic treatment, and the subjective demand for treatment were also recorded. Five areas with varying population structures were studied. The results showed that the prevailing objective and subjective need for treatment varied in the areas studied. The prevalence of objective need for treatment varied between 23.8% and 28.9%. The subjective need for treatment ranged from 21.6% to 30.3%. The highest prevalence of treatment need was found in areas with a large immigrant population. In all the investigated areas was the subjective demand for treatment 1-1.5% less than the objective need for treatment. On the basis of the present data, it can be concluded that neither the objective, nor the subjective need for orthodontic treatment exhibits any tendency to decline. The results do not, therefore, support the policy that the public financial resources for orthodontic treatment could be reduced due to a lowered need for treatment. Severe malocclusions may result in impaired craniomandibular function and have an unfavourable influence on facial and dental attractiveness, which may in turn have psychosocial implications. There is an obvious risk that the frequency of such problems may increase in the population, if children with great or very great need for treatment are denied adequate orthodontic care due to lack of sufficient resources.

Adolescent↗
PubMed2002

The use of a modified CPITN approach to estimate periodontal treatment needs among adults aged 20-79 years by socio-demographic characteristics in the United States, 1988-94.

AIM: The aim of the study was to ascertain periodontal treatment needs and their socio-demographic determinants among adults in the United States by transforming nationally representative periodontal data into an index routinely used internationally. DESIGN: Data were abstracted from a complex, highly stratified, multistage probability cross-sectional study to create a modified Community Periodontal Index of Treatment Needs (CPITN). PARTICIPANTS: 11,339 persons aged 20-79 who participated in the third US National Health and Nutrition Examination Survey (NHANES III), 1988-94. RESULTS: At least 3% of the adult US population required complex periodontal treatment, 90% needed scaling and prophylaxis, and nearly 5% did not need periodontal treatment or oral hygiene instruction. A multivariate cumulative logistic model indicated that being older, male, non-Hispanic black, having lower education, smoking, or not having had a dental visit in the past year increased the likelihood of needing more complex periodontal treatment. The risk factors that indicated the greatest potential for increasing complexity of periodontal treatment, after controlling for all covariates, were being either non-Hispanic black (OR=2.51; 95% CI=1.98, 3.18), or not completing high school (OR=2.10: 95% CI=1.60, 2.77), or a current cigarette smoker (OR=2.02; 95% CI=1.76, 2.33). CONCLUSIONS: The need for increasingly complex periodontal treatment differs by sociodemographic factors. Most American adults need some type of periodontal treatment; however, the majority of periodontal treatment needs in the US are within the clinical skill range of dental hygienists. There is significant disparity in the distribution of need for periodontal treatment; persons from socially disadvantaged groups are more likely to present with increasing complexity of periodontal treatment needs.

Adult↗
PubMed2000

The change of periodontal treatment needs in a population of Ljubljana, Slovenia, over a ten year period.

A follow-up study was performed to assess the change of periodontal treatment needs in the adult population of Ljubljana, Slovenia, over a ten year period. In the initial survey, conducted from 1983-1987, 1,609 dentate subjects in the range from 15-65 years of age were clinically examined. Ten years later of the 1,609 invited subjects a total 555 (34.5%) came to the oral re-examination. During the intervening period 3.1% of them had become edentulous. Periodontal treatment needs in both surveys were assessed by the Community Periodontal Index of Treatment Needs methodology. At the initial examination 2.4% of 1,609 subjects were found to be without any signs of periodontal disease, 97.6% needed oral hygiene instruction, 77.71% needed scaling and 20.3% of them needed complex periodontal treatment. Ten years later, of the 538 dentate subjects aged 25-75 years, only 0.7% of presented with healthy periodontal tissues, 99.3% needed oral hygiene instruction, 93.9% needed scaling and 27.3% needed periodontal surgery. In both surveys advanced periodontal disease in the Ljubljana population was limited to 6.0% and 8.3% of all sextants respectively. After evaluation of the population of the same age in both surveys (25-65-year-old groups) a slight decrease in subjects with healthy periodontal tissues (1.21% vs. 0.84%) was observed. In comparison, there was an increase of subjects with shallow pockets (24.8% vs. 31.1%) and a slight decrease of subjects with deep periodontal pockets (27.7% vs. 24.1%). Comparing the results we concluded that the prevalence and severity of periodontal disease in the Ljubljana population remained similar in both surveys. The findings of the present follow-up study suggest a need for more efficient primary and secondary preventive measures in order to decrease the prevalence and severity of periodontal disease in Ljubljana and Slovenia.

Adolescent↗
PubMed1992

Impact of hospital discharge planning on meeting patient needs after returning home.

This study examines the contribution of hospital discharge planning in meeting the needs of patients for care after their return home. A random sample of 919 admissions (age 60 and over) to five hospitals was studied to obtain information on characteristics of discharge planning during the patients' hospital stay. Specifically, information was obtained on the involvement of a designated professional for managing and coordinating the discharge plan, and the extent to which the planning was interdisciplinary. Patient interviews conducted two weeks after discharge provided information on needs for care related to: (1) treatment, (2) activity limitations, and (3) other self-sufficiency limitations. Patients were asked about their need for care in these three areas and about whether or not these needs were being met. Overall, 97 percent reported one or more needs for care and 33 percent reported that at least one of these needs was not being met. Findings show that the involvement of a discharge planning case manager is related to a significant reduction in unmet treatment needs, but not to reductions in activity limitation, other self-sufficiency needs, or overall needs. No significant effects of interdisciplinary planning were identified. These findings suggest that treatment-related benefits result when a case manager has specific responsibility for the discharge planning of elderly patients returning home after hospitalization. These results provide insights into what is being achieved through current discharge planning practices. The meeting of specific patient needs through enhanced discharge planning may save future costs by reducing the rates of complications and hospital readmissions in an era of prospective payment, thus potentially offsetting the increased costs involved in planning and coordinating postdischarge care for older adults.

Activities of Daily Living↗
PubMed2004

Orthodontic treatment need of Nigerian outpatients assessed with the Dental Aesthetic Index.

BACKGROUND: When limited resources are available for orthodontic treatment, it is important that those with the greatest need receive treatment. AIMS: The aims of this study were to determine the orthodontic treatment needs of Nigerian children and young adults attending a University Hospital as outpatients, and to determine if a relationship exists between social class and orthodontic treatment need. METHODS: Of 148 consecutive patients attending a hospital department for orthodontic treatment, 136 were children and young adults (67 males, 69 females) between 6 and 18 years of age. These subjects were assessed with the Dental Aesthetic Index (DAI), and classified into two social classes with the Standard Occupational Classification. RESULTS: Almost 30 per cent of the children and young adults presenting for treatment had "no/little" need of orthodontic treatment, 20 per cent had DAI scores between 26 and 30 indicating that treatment was "elective", 15 per cent had a "desirable" need for treatment, and 35 per cent had a "mandatory" need for treatment. There was a significant association (p < 0.05) between treatment need and social class: more subjects from the lower social classes (semi-skilled and unskilled occupations) needed orthodontic treatment than subjects from the higher social classes (professional, managerial, and skilled occupations). CONCLUSION: The study has shown that not all outpatients presenting/referred for orthodontic treatment "need" treatment. Patients from the semi-skilled and unskilled occupations were more likely to need orthodontic treatment than patients from the professional, managerial and skilled occupations.

Adolescent↗
PubMedDate not supplied

Self-identified needs of patients with cancer at home and their home caregivers: a descriptive study.

Increasing numbers of patients with cancer are being cared for at home by family caregivers because of the chronicity of cancer and the transition of health care from hospital to home. This study describes the needs of 15 patients with cancer at home and 15 home caregivers. Using the Objects Content Test (OCT), 505 need statements were collected from the subjects. Three hundred patient needs and 192 caregiver needs were identified. Nurse researchers and oncology experts computer Q-sorted the 505 need statements into need categories previously established by Wingate and Lackey. Patients' greatest needs were psychological, physical, and informational. Caregivers' greatest needs were psychological, informational, and those related to household duties. Qualitative data reflected that both patients and caregivers needed support from family or friends, hope, and a sense of the future. Patients indicated a need for purposeful activities.

Adult↗
PubMed1995

Identifying the psychosocial needs of individuals with cancer.

The diagnosis and treatment of cancer creates psychosocial needs that patients often find difficult to resolve. Because most need assessments do not reach beyond enumerating needs to examine barriers to needs resolution, existing social supports or patients' service preferences, we set out to develop a needs assessment inventory to meet these objectives. The first step was to identify need categories using a qualitative methodology. The aims of the research presented in this paper are to: (a) compare patients' and professional caregivers' identification of patients' psychosocial needs, (b) establish categories of psychosocial needs, and (c) verify the categories resulting from the analysis of the data. Twenty-seven need categories were identified. There was a lack of congruency between patients and hospital caregivers and between caregivers at the two cancer centres in the frequencies with which the need categories were cited. The incongruence underscores the importance of gathering information from more than one perspective.

Adult↗
PubMedDate not supplied

Needs of hospice and clinic patients with cancer.

The purposes of this descriptive study were: (1) to compare the self-selected needs of 69 patients with cancer, 31 from a nonprofit hospice, and 38 from a university cancer center located in the mid-south; and (2) to establish the reliability of the Cancer Patient Need Survey for hospice patients. Patients completed the Cancer Patient Need Survey and a demographic data form. Hospice and clinic patients rated the category of coping needs most important. Clinic patients also ranked the category of information needs as a priority, but did not find these needs as well met. Both groups ranked as their top individual needs support from family and friends, and a patient caregiver. Reliabilities of the instrument for the groups range from 0.91 to 0.93. The Cancer Patient Need Survey is a useful instrument for assessing and testing the needs of clinic patients, but additional work needs to be done in modifying the instrument for use with hospice patients.

Adult↗
PubMed1994

Interagency coordination: the key to mainstreaming children with special needs into day care.

While the need for mainstreamed day-care services continues to increase, many barriers remain that prevent or delay providers from enrolling children with special needs. The suggestions in this article to coordinate local resources will help programs begin to provide initial necessary services to children with special needs. The use of volunteers will help supplement the staffing needs of a day-care center and allow for more individualized care of the children. Unfortunately, the absence of public funds for child day care continues to be a major barrier to creating appropriate programs for children with special needs. State and federal policies need to be expanded to support day care in general and children with special needs specifically. Part H of PL 99-457 (now Part H of IDEA PL102-119) is a national impetus to promote interagency collaboration at state and local levels. This is a beginning, but more state and federal funding is needed. In addition, regulations need to be developed that will make it easier rather than more difficult for local agencies to participate. Day-care providers and professionals in every community must work together to provide appropriate services to children with special needs. The most effective services use interdisciplinary teams to work together to plan and implement the care. Let us pick up the challenge of this mandate and develop programs that will help future generations recognize and accept the differences between individuals as well as see the similarities.

Child↗
PubMed1996

Advance care planning for children with special health care needs: a survey of parental attitudes.

OBJECTIVES: This study explored parental attitudes about their interactions with their children's providers when decision making involved critical life situations. We evaluated parents' attitudes regarding the following questions: What was the parents' understanding of their children's health care issues, and what was the parental perception of the professionals' understanding of their children and of themselves? Who should be the principal decision makers for the children? What was the parents' knowledge about advance directives? Did parents want to participate in a process of advance planning to assist with critical life decision making for their children? METHODS: We surveyed all parents attending a conference sponsored by the Massachusetts Department of Public Health for parents of children with special needs. The questionnaire was provided to all parents attending the conference. An announcement was made at the conference requesting parental participation. The 76 respondents constitute a convenience sample of parents of children with special needs sufficient for this preliminary stage of investigation. RESULTS: Of 177 parents attending the conference, 76 (43%) completed the questionnaire. Eighty-eight percent of the participants strongly agreed that they understood their children's conditions. Twenty-one percent stated that they had sufficient understanding of their children's future medical needs, and 21% thought that they had a sufficient understanding of their children's developmental potential. Ninety-nine percent of parents strongly agreed that physicians should share information with parents no matter how serious or potentially upsetting. Ninety-four percent of those parents who thought that their children's physicians understood their own needs also thought that the physicians understood their children's needs. In contrast, only half (55%) of those parents who thought the physicians did not understand their needs thought the physicians understood their children's needs. Ninety-two percent of parents who thought that the physicians understood their needs agreed that the physicians would make the best decisions in crises versus 60% of those who did not think the physicians understood their needs. Seventy-four percent stated that they would consider written guidelines for their children that dealt with critical life situations. All parents who thought their children's conditions were not understood wanted written guidelines. Of those parents who had thought their children would not survive (15 parents), 94% wanted written guidelines. All seven parents who had been told their children would not survive wanted written guidelines. CONCLUSIONS: Parents in this study were generally satisfied with care being provided to their children. Nevertheless, the results clearly suggest goals that could lead to improved capacity for parents and providers to make critical life decisions for and with children. First, physicians must understand the needs of parents to be able to make decisions that would be in the children's best interests. Second, parents should participate fully in critical life decisions for their children and should use written guidelines to assist with the process of these critical life decisions. Our findings strongly support the development of a longitudinal process, initiated early after the onset or discovery of illness and maintained longitudinally throughout the course of a child's illness, to help parents and providers work together in this vital area of health care to children.

Adult↗
PubMed1996

Measuring the need for medical care in an ethnically diverse population.

OBJECTIVE: To examine measures of need for health care and their relationship to utilization of health services in different racial and ethnic groups in California. DATA SOURCE: Telephone interviews obtained by random-digit dialing and conducted between April 1993 and July 1993 in California, with 7,264 adults (ages 18-64): 601 African Americans, 246 Asians, 917 Latinos interviewed in English; 1,045 Latinos interviewed in Spanish; and 4,437 non-Latino whites. STUDY DESIGN: A cross-sectional survey was conducted from a stratified, probability telephone sample. DATA COLLECTION: Interviews collected self-reported indicators of need for health care: self-rated health, activity limitation, major chronic conditions, need for ongoing treatment, bed days, and prescription medication. The outcome was self-reported number of physician visits in the previous three months. PRINCIPAL FINDINGS: Compared to whites, one or more of the other ethnic groups varied significantly (p < .05) on each of the six need-for-care measures after adjustment for health insurance, age, sex, and income. Latinos interviewed in Spanish reported lower percentages and means on five of the need measures but the highest percentage with fair or poor health (32 percent versus 7 percent in whites). Models regressing each need measure on the number of outpatient visits found significant interactions of ethnic group with need compared to whites. After adjustment for insurance and demographics, the estimated mean number of visits in those with the indicator of need was consistently lower in Latinos interviewed in Spanish, but the differences among the other ethnic groups varied depending on the measure used. CONCLUSION: No single valid estimate of the relationship between need for health care and outpatient visits was found for any of the six indicators across ethnic groups. Applying need adjustment to the use of health care services without regard for ethnic variability may lead to biased conclusions about utilization.

Adolescent↗
PubMed1987

Correlates of community resource information needs of arthritis patients.

One hundred eighty-nine ambulatory arthritis patients were interviewed to assess needs for information about community resource services. Participants were asked how frequently they needed 66 specific information items. Three categories of resource needs in arthritis care were identified: general information, personal care and medical services, and assistive devices and equipment. In the first category, results indicated that the greater the impairment in functional ability, the greater the need for general information about arthritis. When functional ability was held constant, younger patients with lower family income displayed a greater need for arthritis resource information. Lower functional ability and family income were associated with a greater need for personal care and medical service information. Lower functional ability contributed the most to the need for information about assistive devices and equipment. We suggest that, as an essential component of the long-term care of patients with rheumatic diseases, individuals who provide educational counseling should clearly understand the community resource needs of patients, and should be able to match articulated needs with the existing services. Health professionals should be aware that certain patient characteristics (specifically, family income, functional ability, and age) are related to a need for this type of information. The large percentage of patients who could not name their rheumatic disease diagnosis (65%) presents a major concern and challenge to patient educators.

Activities of Daily Living↗
PubMed2005

Need for information and for involvement in decision making among patients with rheumatoid arthritis: a questionnaire survey.

OBJECTIVE: To measure the need for information about rheumatoid arthritis (RA) and the level of desire for involvement in treatment decisions among patients with RA. To examine the relationship between these preferences and what factors (sociodemographic, disease, treatment, level of disability, and level of knowledge about RA) associate with these preferences. METHODS: Questionnaire surveys were mailed to a randomly selected group of 600 patients with RA. Need for information and desire for involvement in decision making were measured using a validated tool (the Autonomy Preference Index). RESULTS: The response rate was 57.3%. The need for information was very high. Information seeking preference scores (median 82.5, interquartile range 80.0-92.5) were significantly higher (P < 0.001) than decision making preference scores (mean +/- SD 56.4 +/- 13.6). Need for information and for decision making were both higher in women than men, and associations with these needs differed in men and women. However, younger age and greater knowledge of RA predicted greater need for decision making. There was no correlation between need for information and for involvement in treatment decisions for either sex (women: r(s) = 0.09, P = 0.19; men: r(s) = -0.06, P = 0.54). CONCLUSION: There was a high level of need for information among patients with RA. Desire for involvement in treatment decision making was significantly lower and did not correlate with need for information. Associations with these needs differed for men and women.

Adult↗
PubMed1992

The continuing medical education needs of anaesthetists.

Learning needs assessment is the term applied to the process of identifying or diagnosing a learner's educational needs. It is the foundation of a systematic continuing medical education (CME) programme. Needs assessment has been identified as the most pressing problem of medical education directors in North America. Furthermore, the CME learning needs, interests or motivations of anaesthetists have never been studied. The amount of time and effort required for needs assessment is probably a major deterrent to this activity. The investigators adopted simple and straightforward means of assessing the "perceived learning needs" and topic interests of anaesthetists. Questionnaires were sent by mail to anaesthetists practicing in teaching and non-teaching hospitals in the Toronto area. The questionnaire presented a list of CME content areas. The respondents were asked to indicate on scale of 1 to 10 their Current Expertise, Ideal-Desired Expertise, and Interest-Motivation levels for each content area. Need Score for each content area was calculated by taking the difference between Ideal and Current Expertise responses. A total of 101/305 anaesthetists (29%) responded to the survey. Most of the respondents had been in anaesthesia practice for less than ten years. Regional nerve block, acute pain control, and medicolegal considerations received high overall ranks in both the need and interest categories. Paediatric anaesthesia, anaesthesia for trauma surgery and thoracic anaesthesia had top ranks among the subspecialty fields. Regional anaesthesia techniques received higher need and interest ranks than intravenous and inhalational techniques. The learning needs of anaesthetists of a large urban centre have been identified, and this information is useful to CME planners.

Anesthesiology↗
PubMed1993

Pastoral needs and support within an inpatient rehabilitation unit.

Because patients reported concerns regarding the adequacy of pastoral service delivery during their inpatient rehabilitation hospitalization, a study was performed to ascertain the patient's pastoral needs and the extent of pastoral services provided. After discharge from the inpatient rehabilitation hospital, patients were surveyed as to their perceived religious and spiritual needs, as well as to the extent of religious, spiritual, and pastoral services provided during their inpatient stay. The majority of responders (74%) reported their religious and spiritual beliefs were important. Forty-five percent of responders indicated not enough attention was repaid to their religious or spiritual needs, whereas only 1% felt that too much attention was paid. A majority of patients (54%) desired pastoral visitation. Other needs were elicited, including expanded pastoral services, increased staff empathy for the patient's spiritual and religious needs, and improved availability of church or synagogue services or sacraments. Many Jewish patients reported concerns of being punished by God, whereas Christian patients were concerned that God was unaware of their personal needs. Some responders, regardless of personal faith, were also troubled with fears of death, God's failure to heal, and loss of purpose in life. There is a clear need to establish a mechanism to identifying the religious and spiritual needs of each individual patient. These needs must be considered with both sensitivity and compassion by all members of the rehabilitation staff. The rehabilitation facility must also develop a mechanism to identify pastoral care resources available within the hospital and local community, and to assure that the patient's needs are addressed.

Aged↗
PubMed2006

Long-term survival from gynecologic cancer: psychosocial outcomes, supportive care needs and positive outcomes.

OBJECTIVES: To assess the long-term psychosocial outcomes and supportive care needs of gynecologic cancer survivors. METHODS: Women who had received care in a tertiary-based gynecologic cancer center 1-8 years earlier and who were disease-free were invited to complete a mailed self-report questionnaire to assess psychosocial outcomes and supportive care needs. RESULTS: In total, 199 survivors participated in the study. Survivors reported normal quality of life and relationship adjustment although functioning was at the lower end of the range; over two-thirds (68%) reported positive outcomes. However, nearly one-third (29%) reported clinical levels of anxiety and the most frequently endorsed need concerned fear of disease recurrence (24%). About one-fifth (19%) reported symptoms that indicated posttraumatic stress disorder (PTSD) and this rose to close to one-third (29%) for survivors of advanced stage disease. Nearly 90% of survivors reported supportive care needs and the diagnosis of anxiety or PTSD resulted in a four-fold increase in unmet needs. Needs most frequently concerned "existential survivorship" (e.g., spiritual beliefs, decision making, the meaning of life) and "comprehensive cancer care" (e.g., team care, communication, local health care services). Years since diagnosis was not related to distress or need levels. CONCLUSIONS: All members of the care team need to be aware that significant psychosocial morbidity may occur many years after the successful treatment of a gynecologic malignancy and may be associated with elevated supportive care needs. Comprehensive and extended supportive care services are required to address anxiety and trauma responses and investigate strategies to meet ongoing needs in order to improve long-term psychosocial outcomes.

Adult↗
PubMed1989

Using a survey to assess perioperative staff learning needs.

The learning needs survey is an effective means of ranking staff learning needs. The learning needs survey should be used every year to reevaluate the staff's needs and to incorporate new content areas. Newly hired nurses should take the survey only after they have been employed six months. The survey allows the educator to differentiate the needs of the new versus experienced staff, and it involves the staff in planning for their personal needs. The use of a learning needs survey keeps the content focused on the learner as opposed to the instructor's interest or needs. The staff rated needs differently than the instructor. For example, the staff rated a review of pediatrics growth and development low (13) even though there is an increased number of outpatient pediatric cases at our facility. Staff members' comments also provide data for follow-up and more specific surveys. A learning needs survey is the first step in providing continuing education for the perioperative staff.

Evaluation Studies as Topic↗